BACKGROUND: Apolipoprotein E (APOE) plays a vital role in cholesterol metabolism, and insulin resistance (IR). This study aimed to estimate the prevalence of IR and the impact of apolipoprotein E gene polymorphisms on the occurrence of IR in healthy Iraqi people. METHODS: A cross-sectional study on 203 healthy individuals measured glycemic, lipid, and insulin resistance profiles. ROC evaluations and DNA testing forAPOE gene alleles were performed, aligning with NCBI reference sequences. RESULTS: The study found that the E3E4 genotype was more prevalent in individuals with insulin resistance (12.82%) than in insulin-sensitive individuals (5.15%). The E3 allele was also more prevalent in individuals with insulin resistance at the allelic level (94.62%). Age, body mass index, and waist-to-hip ratio were significantly associated with insulin resistance. CONCLUSIONS: APOE gene polymorphisms rs429358 and rs7412 may be risk factors for insulin resistance. This study indicates that the epsilon 3/ epsilon 3 genotype is significantly associated with insulin resistance. No association was found between different hapolgenotypes and lipid or glycemic profiles.

Background: Diabetic peripheral neuropathy (DPN) brought on by damage to the peripheral sensory and motor nerves. Since the F-wave passes through both the afferent and efferent pathways in the motor nerve, alterations in the F response parameters may indicate injury to either of these pathways. Objective: To explore the effectiveness of ulnar F-wave parameters in diagnosing subclinical neuropathy in patients with type 2 diabetes mellitus (T2DM). Methods: The study examined F-wave, glycated hemoglobin (HbA1c), and modified Toronto clinical neuropathy score (mTCNS), in addition to sural to radial amplitude ratio, sensory and motor conduction of upper and lower limb nerves, in 116 T2DM patients and 121 control participants. Results: In comparison to controls, DPN patients exhibit longer F-minimum (Fmin), F-maximum (Fmax), F-ratio (Fr), and modified F-ratio (mFr). Along with higher F-chronodispersion (Fc) and F-estimate (Fe), they also show lower F-persistence (Fp), F-wave conduction velocity (FWCV), and F-index (Fi). Patients with DPN have higher F-estimate (Fe) values than the controls, whereas patients without DPN have lower Fi. There was a strong correlation observed between several F-wave parameters and the mTCNS, disease duration, and HbA1c. Conclusion: Increased mFr value, longer Fm latency, and higher Fi value were useful in the early identification of subclinical DPN, while higher Fi value, FWCV slowing, and prolonged Fmin and Fmax latencies helped identify patients with clinical DPN. When separating diabetics with T2DM from those without DPN, the Fi value has the highest sensitivity and specificity. Keywords: DM, subclinical neuropathy, ulnar nerve, F-wave. Citation: Abdul Qader AA, Hamdan FB, Khudhair MS. Ulnar F-wave study in the detection of subclinical diabetic neuropathy. Iraqi JMS. 2025; 23(2): 282-296. doi: 10.22578/IJMS.23.2.11

BACKGROUND: Anthropometric tests significantly facilitate the evaluation of Type 2 diabetes mellitus (T2D), hypertension, and cardiovascular disorder. Nevertheless, limited research has examined the correlation between various anthropometric characteristics and insulin resistance (IR). METHODS: This study intended to assess the relationship between IR and various anthropometric parameters, encompassing [waist circumference, hip circumference, Body Mass Index (BMI), waist-to-hip ratio, Visceral Adiposity Index (VAI), and lipid accumulation product (LAP)], and ascertain the most effective anthropometric parameter for enhancing clinical prediction of IR Iraqi healthy persons. The Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was utilized to assess IR. This cross-sectional study contained 203 healthy participants. Measurements were taken for fasting insulin, fasting blood glucose, and glycosylated hemoglobin. Demographic variables such as age, gender, smoking habits, place of residence, and family history of diabetes were obtained by direct contact. The participant's body weight (in kilograms) and height (in centimeters) were measured under the condition that they were wearing light clothes and without wearing shoes. The BMI was determined by using the following equation: Weight (kg)/square height (m2). Measurements were taken for waist circumference, hip circumference, waist-to-hip ratio, lipid accumulation product, and VAI. RESULTS: Participant's age, BMI, and waist-to-hip ratio were higher in insulin resistant (59.96 +/- 12.28), (26.66 +/- 3.16), and (0.93 +/- 0.05) respectively than insulin sensitive (54.19 +/- 9.88), (25.92 +/- 2.4), (0.91 +/- 0.05) with significant difference (P value 0.013, 0.013, 0.029) respectively. Similarly, the LAP and VAI were also substantially higher in the group that resisted insulin versus the insulin-sensitive group (P=0.004, P=0.015, respectively). CONCLUSIONS: The study stated that IR was definitely correlated with BMI, WHR, VAI, and LAP and waist to hip ratio. It is supposed to be a good surrogate marker of resistance to insulin in Iraqi healthy subjects. Therefore, when altering techniques to decrease IR risk, greater attention might be dedicated to variations in body weight and abdominal adiposity. These free, self-assessing anthropometric measures are dependable instruments to promote the enhanced implementation of IR screening in a community context among healthy Iraqi individuals.

The goal of this study is to compare the brain connectivity patterns of autistic patients with those of children who are developing normally and analyzing quantitative electroencephalography in children with autism. The study included 50 children who were developing normally and 60 preschoolers who met the DSM-V criteria for autism spectrum disorder. Routine and quantitative electroencephalography were carried out on each subject, as well as a Childhood Autism Rating Scale. The electroencephalograms of 76.67% of autistic children were normal; 6.67% showed focal changes, and 16.67% showed generalized changes. While the alpha power in the central and temporal areas is significantly lower in autistic children, it is unchanged in the frontal and parieto-occipital regions. Children with autism have significantly higher absolute delta and theta band activity both globally and locally. It was shown that the total and regional absolute delta and theta power activity had a significant positive correlation with the disease severity score. Quantitative electroencephalography is a more effective tool for assessing and diagnosing children with autism spectrum disorder because it shows abnormalities in all autistic children. A correlation exists between the quantitative electroencephalography data and the disease severity score.

Introduction and Aim: In developed countries, carotid artery stenosis (CAS) has a considerable impact on mortality and disability rates. Genetic risk factors for CAS have also been linked, in addition to environmental risk factors. This study sought to determine whether there may be a link between three polymorphisms in the LPL gene and the emergence of CAS. Materials and Methods: One hundred and twenty participants were enrolled in this case-control study, including 60 individuals with CAS and 60 healthy subjects serving as the control group. The demographic and clinical data were collected from each participant. Whole blood samples were obtained to study the genomic DNA where a specific LPL gene fragment corresponding to the three single nucleotide polymorphisms (SNPs) rs320, rs328, and rs285 was amplified using designated primers. Restriction fragment length polymorphism analysis was used for genotyping. Results: The mutant allele (C) of the rs285 polymorphism was more frequent in patients than controls (45% vs. 32.5%; OR=1.7, 95% CI= 1.01- 2.87; p=0.048). The TCC haplotype block (T allele of rs320, C allele of rs285, and C allele of rs328) was significantly more prevalent in patients compared to controls (OR= 2.0, 95% CI= 1.03-3.77, p= 0.039). On the other hand, controls (23.33%) had significantly more of the haplotype block GTG than did patients (8.33%) (OR = 0.3, 95% CI = 0.14-0.065, p = 0.002). The SNPs rs320 (D' = 0.63) and rs328 (D' = 0.61) have weak relationships with rs385. Conclusion: The C allele of rs285 polymorphism could be considered a risk factor for CAS. While the haplotype block GTG was thought to play a protective role, the haplotype block TCC (T allele of rs320, C allele of rs285, and C allele of rs328) may increase the risk of CAS.

Introduction and Aim: The miR-146a is a short non-coding RNA molecule that has both therapeutic and biomarker potential. Abnormal miR-146a expression has been linked to several disorders. The target of the study is to investigate the possible link between miRNA-146a expression and the deterioration of cognitive function in Alzheimer's patients. Materials and Methods: The research comprised 40 individuals from Iraq, spanning both genders and ranging in age from 60 to 85 years. They were segregated into two distinct groups. The first group included 40 subjects (age of 75±6.6 years) who displayed no signs of cognitive or functional impairment. The second group consisted of 40 patients diagnosed with Alzheimer's disease (with an average age of 74.98±5.03 years), as per the DSM-5 criteria. To assess the mir-146 gene expression, quantitative polymerase chain reaction (qPCR) was employed. Results: The median expression of miR-146a in Alzheimer's disease was 0.97-fold greater than in control, with no statistically significant difference. There were no significant differences in the means between Alzheimer's females and Alzheimer's males. Female control subjects had considerably higher mean ADAS-cog scores than male control subjects. In Alzheimer's disease patients, age was observed to be strongly associated with ADAS-Cog scores, showing that age plays a role in disease development. Conclusion: Serum miR-146a is not related to the development of Alzheimer disease and does not affect disease progression

Nicotine dependence (ND) and visceral adiposity are emerging as independent risk factors for cardiovascular diseases, including carotid artery stenosis (CAS). This study aimed to determine the relationship between ND and the contribution of abdominal fat to the onset of CAS, which is indicated by a luminal narrowing of at least 60% as determined by duplex and/or Doppler ultrasound. We prospectively collected data from 60 patients with CAS and 60 age- and gender-matched healthy subjects. The Fagerström Test for Nicotine Dependence (FTND), a common research tool, was used in the study. The original questionnaire was designed to gather social and demographic data. Anthropometric measurements, visceral adiposity index (VAI), and lipid accumulation products (LAP) were used to assess obesity. Most patients showed a high or mild-moderate degree of ND: 46.67% and 35%, respectively. The median visceral adiposity index (VAI) and lipid accumulation product (LAP) in patients was 3.92 and 32.83, respectively. Prolonged smoking duration, increased intensity, and high ND are hallmarks of CAS patients.

INTRODUCTION:Post-stroke spasticity (PSS) is a disorder of the sensory-motor control, leading to upper motor neuron lesions manifesting either as intermittent or sustained involuntary activation of muscles. Botulinum neurotoxin-A (BoNT-A) is mostly utilized in a variety of therapeutic indications, and it is effective and safe in the management of focal PSS in the rehabilitation scenario. The study aimed to evaluate the effect of BoNT-A administration on H-reflex of upper and lower limbs following PSS. In addition, the investigation of the association among the degree of spasticity (assessed by the Modified Ashworth Scale [MAS]) and motor neuron pool excitability (assessed by analysing H-reflex excitability) was done.MATERIAL AND METHODS:Fifty patients with a stroke of either sex aged 30 to 60 years presented with either upper or lower limb focal spasticity were studied. BoNT-A was given on two occasions to the gastrocnemius, soleus, biceps brachii muscles and flexor carpi radialis (FCR). H-reflex was documented from the FCR and soleus muscles at baseline and 3-4 weeks post BoNT-A injection. Medical Research Council scale and MAS were used to assess the PSS and muscle strength.RESULTS:H-reflex latency and amplitude, H/M ratio recorded from FCR and soleus muscles were significantly different between pre- and post-management. The MRC scale was significantly increased whereas the MAS was significantly reduced post BoNT-A injection.CONCLUSIONS:BoNT-A causes obvious improvement in PSS clinically as assessed by MAS and MRC scale as well as neurophysiologically by H-reflex. A negative correlation between H-reflex latency but not the amplitude or H max /M max ratio and MAS was observed.

Despite the well-acknowledged link between autism spectrum disorders (ASDs) and epilepsy, the prevalence and significance of electroencephalogram (EEG) changes in epileptic children in the absence of clinical seizures remains underdetermined. Aim. The primary goal of this study is to report the prevalence of EEG abnormalities in non-epileptic or pre-epileptic autistic children, investigate their association with a set of pre-determined risk factors, speculate on their significance, and direct future research efforts. Methods. A case-based sampling for children diagnosed with autism was done. Only patients without a history of epilepsy and those under the age of 15 were included. All patients underwent an EEG study. Children with abnormal EEG findings (case group) were compared to age-matched controls with normal EEG findings using a set of pre-determined factors. Results. A total of 38 patients were enrolled in our study, of whom 31.6% (n=12) had abnormal EEG readings. Of those, the presence of the following EEG abnormalities were noted – each being present in two patients: frontal sharp waves, frontal slowing, temporal slowing, bitemporal slowing, frontal sharp waves, and generalized sharp waves, Frontal intermittent rhythmic delta activity (FIRDA). Patients with abnormal EEG findings were more likely to have a positive family history of epilepsy and/or autism, with odd ratios of 28.05, and 12.62, accordingly. Conclusion. Aberrant brain connectivity patterns have been observed in non-epileptic ASD patients, and our findings support these findings. Furthermore, we believe that gender, mother's age, mode of delivery, and speech abnormalities could all have an impact on the EEG results. However, more research is needed to expand on these findings.

Background There is increasing evidence that prolonged or recurrent seizures can cause or exacerbate cognitive impairment (CI) in memory, attention, orientation, and visuospatial and abstraction disabilities, all of which can jeopardize educational progress and achievement throughout life. The objectives of our study are to assess the cognitive functions in people with epilepsy (PwE) using P300 event-related potentials (ERPs), and correlate each P300 components with six explanatory variables (epilepsy type, seizure type, NHS3 score- seizure severity, disease duration, age at first seizure, and the number of anticonvulsant medications). Methods One hundred and two PwE [52 with focal epilepsy and 50 with generalized epilepsy, as classified by the International League Against Epilepsy in 2017]. They underwent electroencephalography (EEG) and P300. The Montreal Cognitive Assessment (MoCA) scale was used to assess baseline cognitive functions. Results Epileptic patients showed significant latency prolongation and amplitude reduction of P300 as compared to non-epileptic population. Longer P300 latency and lower amplitude were seen in patients with abnormal EEG records. P300 latency was longer in patients using poly-therapy. P300 components correlated well with age at presentation and disease duration but not with NHS3. According to epilepsy type, 50.98% of PwE had focal epilepsy and 49.02% had generalized epilepsy, 85.29% of them had abnormal EEG recording. Considering seizure type, 47.06% had a generalized tonic–clonic seizure, 38.24% had a focal to bilateral tonic–clonic seizure, 20.59% had a myoclonic seizure, 12.75% had a focal with impaired awareness seizure, 3.92% had a focal aware seizure, and 2.94% had an absence seizure. Seventy-seven PwE had one type of seizure, while 25 had more than one type of seizure. The NHS3 score was higher in those with a single seizure type than in those with multiple seizure types. Conclusion All seizure types had an abnormal P300 component, indicating cognitive function deficits. P300 may be a promising objective method for assessing cognitive function in PwE. The number of antiepileptic drugs used, the presence of EEG abnormalities, the age at presentation, and the duration of the disease are the factors that best correlate with cognitive impairment (CI).

Background: A stroke is a serious life-threatening medical condition that occurs when the blood supply to part of the brain is disrupted. Spasticity is a state, in which, there is an increase in muscle tone or stiffness, which might be associated with movement and speech disorders. Spasticity is usually caused by damage to nerve pathways within the brain or spinal cord that control muscle movement. The H-reflex is a compound electromyographic (EMG) response composed of group Ia (and large group II) afferents from muscle spindles (and Golgi tendon organs) that project monosynaptically (and to a lesser extent di- and tri-synaptically) to spinal efferent ?-motoneurons (?MN), which in turn activate the muscle after an electrical current is applied to the nerve. Objective: To assess the Medical Research Council (MRC) scale in post stroke spasticity patients and to estimate the neurophysiological changes in those patients regarding H-reflex and Hmax/Mmax ratio. Methods:A randomized clinical trial involves 50 patients with stroke of both sexes. Their age ranged from (30-60 years old) suffering from upper and lower limb spasticity. They were assessed by the MRC scale to determine the grade of power of muscle. The neurophysiological test is done by using the H-reflex for both upper and lower limbs (flexor carpi radialis and soleus muscles, respectively). The maximum amplitude was measured from the peak of the first positive deflection to the peak of the negative one. The latency and the Hmax/Mmax ratio were also measured. Results: The result of this study showed a significant decrease in MRC in spastic patients (P value ?0.001). H-reflex latency in lower limbs was significantly decreased from (30.3±2.4 ms) in the normal population to (18.5±1.3) in the spastic patient. The H reflex amplitude in the lower limb was significantly increased in post stroke spasticity patients (P value ?0.05). In the upper limbs H-reflex latency in flexor carpi radialis was also significantly decreased. Regarding H reflex amplitude of the upper limb in the spastic patient was significantly increased. There is a noticeable increase in the H/M ratio in post stroke spasticity patient which was (0.51±0.92) with a significant P value of 0.005. Conclusion: Patient with post stroke spasticity had decreased in MRC scale, while H-reflex has decreased in latency and increased in amplitude, as well as decreases in Hmax/Mmax Ratio in both upper and lower limbs. Keywords: Post stroke spasticity, H-reflex latency, H-reflex amplitude, H/M ratio, MRC scale. Citation: Fawzi SM, Hamdan FB, Al-Gawwam GA, Jaafar IF. Neurophysiological changes in post stroke spasticity patients. Iraqi JMS. 2023; 21(2): 254-259. doi: 10.22578/IJMS.21.2.13

Alzheimer's disease (AD) dementia is the most frequent cause of neurodegenerative dementia. The cognitive and behavioral symptoms associated with this disorder often have overlapping characteristics, potentially resulting in delayed diagnosis or misdiagnosis. This study aimed to assess the level of peripheral blood neurofilament light chain (NfL) and total tau (t-tau) protein in AD patients and investigate their relationship with cognitive impairment. The study included 80 participants of both sexes between the ages of 60 to 85 years. The participants were divided into two groups, consisting of 40 individuals in the control group (mean age 75±6.6 years) who had no cognitive or functional impairments and 40 AD patients (mean age 74.98±5.03 years). This study utilized the DSM-5 diagnostic criteria for major or mild neurocognitive disorder attributed to Alzheimer's disease (AD). The clinical and biochemical features of all participants were documented, and the Alzheimer's disease Assessment Scale cognitive subscale (ADAS-cog) scores were evaluated. Sandwich ELISA was employed to determine serum NfL and t-tau protein levels. The median serum NfL and t-tau protein levels in AD patients were significantly higher than those of the controls (47.84 pg/ml versus 17.66 pg/ml and 12.05 pg/ml versus 11.13 pg/ml, respectively). Age was positively correlated with NfL, t-tau levels, and ADAS-cog. Although elevated NfL and t-tau protein levels may play a role in disease progression, their diagnostic value for AD was limited.

Background: Cervical spondylotic myelopathy (CSM) is a neurodegenerative disease caused by repetitive spinal cord damage that has resulted in significant clinical morbidity. The clinical evaluation of signs and symptoms, as well as neuroimaging and several neurophysiological tests, are used to make the diagnosis.Objectives: To investigate changes in the cutaneous silent period (CuSP), cortical silent period (CoSP), and H-reflex in CSM patients, and to correlate these tests with the Japanese Orthopedic Association (JOA) score and Nurick's grading, as well as to determine the diagnostic value of each of them.Methods: Twenty patients (14 males and 6 females) with CSM were clinically diagnosed and documented by magnetic resonance imaging (MRI), and they were paired with another 20 healthy volunteers (13 males and 7 females) as a control group. CuSP, CoSP, and H-reflex tests were performed on both groups.Results: In CSM patients, CuSP latency and duration are substantially longer and shorter in CSM patients, respectively. The degree of changes in CuSP latency is well correlated with the severity of the disease. Further, CoSP duration is significantly shortened. The H-reflex parameters did not differ significantly between the patient and control groups. Conclusion: The shortened CoSP's duration and the prolonged CuSP's latency suggest malfunction of the inhibitory and excitatory circuits in the spinal cord. The CuSP is more sensitive and specific than the CoSP in the diagnosis of a patient with CSM.

Background: Autism spectrum disorder (ASD) is a heterogeneous behavioral disorder that is characterized by qualitative deficits in social communication and interaction and restricted, repetitive behavioral patterns, activities, and interests. For an optimum outcome in children with autism, early intervention (preferably before three years of age) is essential. Hence, there is a critical need to improve the awareness of ASD to enable earlier detection and intervention. The present study aims at achieving the following: (1) Investigating neural transmission within the visual system using visual evoked potentials (VEPs) as an index of the myelination process of the visual pathway. (2) Correlating the changes in the VEPs with the clinical severity of autism. (3) Investigating the possible gender differences in VEPs in autistic children. Materials and Methods: The study was conducted on 60 preschool children (11 females and 49 males) who were recruited from the autism center and the pediatric neurology ward and who met the DSM-V criteria for autism in the Pediatric Hospital for the period from 12 December 2019 to 1 June 2021. Their mean age was 4.5±1.17 years. Another 50 (40 males and 10 females) age- and gender-matched normally developed children served as the control group. Both groups were subjected to a detailed history, as well as complete physical and neurological examinations. The VEPs were assessed for all of them. The autistic children were excluded from the study if they had any motor, visual impairment, inborn errors of metabolism, epilepsy, other chronic medical or neurological disorders, or if they were taking medications during the period of study. Results: The P100 wave latency of the VEPs was significantly prolonged in both eyes of autistic children as compared with that of the control group. The N75-P100 amplitude was significantly lower in the left but not the right eye of patients when compared with those of normally developed children. Neither the P100 wave latency nor the N75-P100 amplitude of both eyes was associated with the gender or severity of illness. Conclusion: There are distinct changes in VEPs in autistic children, especially the abnormal prolongation of conduction time, suggesting that autistic children may have brainstem and visual pathway dysfunction. Gender and disease severity score have no impact on VEPs.

Background: The pathogenesis of migraine is thought to include activation of the trigeminovascular system. The blink reflex (BR) test is a well-known method of studying the trigeminal system. Objective: To look into the differences in BR response in migraine patients using the standard approach and to compare the results with matched control subjects, looking for a possible difference in BR ictally and interictally, and clarify whether migraineurs with aura differ from those without aura. Methods: A case-control study of 80 subjects; 40 patients were diagnosed with migraine, with or without aura, and 40 matched healthy volunteers. Disease duration ranges from 2 to 82 months. Both groups were submitted to medical history, clinical neurological examination, and binocular BR study of both eyes. Results: BR data were not different between male and female patients. Right cR2 latency and left iR2 were prolonged in the migraineurs group patients. Right iR2 and cR2 latencies recorded interictally were longer than those obtained ictally. No difference was observed between those with and without aura. The pain location side is not associated with the stimulation side. Conclusion: Patients suffering from episodic migraine may have altered interneuronal brainstem circuits. BR data would not change whether migraine was with or without aura. Interictal changes in BR suggest trigeminovascular dysfunction in migraineurs patients is not a transient phenomenon. Keywords: Migraine, Blink Reflex Citation: Esmael ZF, Hamdan FB. Blink reflex study in patients with migraine. Iraqi JMS. 2022; 20(2): 175-182. doi: 10.22578/IJMS.20.2.3

Introduction Motor neuron loss is the primary pathologic feature of amyotrophic lateral sclerosis (ALS). An estimate of the number of surviving motor units (MUs) represents a direct measure of the disease state in ALS. The objective of the study is to compare MU number estimation (MUNE) using the multipoint stimulation method (MPS) and compound muscle action potentials (CMAP) amplitude in patients with ALS. Methods Twenty-eight patients with ALS with a disease duration of 3–48 months were studied. Nerve conduction study of the median, ulnar, tibial, common peroneal, and sural nerves were done. Besides, electromyography (EMG) of cranio-bulbar, cervical, thoracic and lumbosacral muscles, and MPS-MUNE. Results MUNE is decreased in patients with ALS. MUNE was positively correlated with CMAP amplitude, medical research council (MRC) scale, and ALS functional rating scale (ALS-FRS). On the contrary, MUNE was negatively correlated with MUAP duration. Case detection by the MUNE methods was high as compared to that of CMAP amplitude. Conclusions MUNE is highly specific and more sensitive than CMAP amplitude in detecting the neurophysiologic abnormalities in patients with ALS. Case detection by MUNE is three times more than CMAP amplitudes. The rate of decline of motor units using the MPS-MUNE is more sensitive than the MRC score and ALSFRS-R when expressed as the percentage change from baseline.

Background About 40–70% of patients with multiple sclerosis (MS) develop cognitive impairment (CI) throughout their life. We aim to study the influence of MS on cognitive changes. This is a case–control study of fifty patients with MS who met the revised 2017 Mc Donald Criteria and fifty age- and sex-matched healthy subjects. The Expanded Disability Status Scale (EDSS) was used to assess the degree of disability, and the Montreal Cognitive Assessment (MoCA) scoring system was used to assess cognitive function. Results MS patients show low total MoCA score than the controls. Total MoCA scores were lower in patients with CI versus those with intact cognition. CI was higher in those with a longer duration of illness and a high EDSS. MoCA was positively correlated with education level but negatively with EDSS and disease duration. Conclusion MoCA scale has optimal psychometric properties for routine clinical use in patients with MS, even in those with mild functional disability. The longer the disease duration and the higher the EDSS, the lower the MoCA score and the higher the education level, the higher the MoCA score. As for the profile of cognitive dysfunction in patients with MS, the domains most frequently failed by the patients were memory, attention, visuospatial learning, and language.

The impairment of cardiovascular autonomic control among the underdiagnosed complication of diabetes mellitus (DM) with a high prevalence rate of up to 60% in type 2 DM (T2DM). Cardiac autonomic neuropathy (CAN) is an independent risk factor for cardiovascular mortality, arrhythmia, silent ischemia, any major cardiovascular event, and heart failure. We aimed to evaluate cardiovascular autonomic activity by different physiological maneuvers, study risk factors for diabetic CAN including age, gender, duration of diabetes, body mass index (BMI), and glycemic control, and correlate CAN stage with risk factors. One hundred and forty-two T2DM patients consisted of 62 males and 80 females and 100 volunteers as a control sample. Cardiac autonomic functions were assessed by Ewing's tests. Glycated hemoglobin (HbA1c), body weight, height, body mass index (BMI), and waist-hip ratio (WHR) were also measured. Cardiovascular autonomic functions and Ewing scores were significantly different in people with diabetes when compared with control healthy subjects. Ewings test values and Ewing scores were significantly different between diabetics with and without CAN and within patients with different CAN staging. People with diabetes with CAN have a significantly longer duration of disease when compared to those without CAN. A strong association has been found between CAN severity and patient age, duration of disease, HbA1c severity, and the WHR ( P < 0.001) but not with BMI. The duration of disease and HbA1c level appear to be associated with the development of CAN ( P = 0.001 and P = 0.008, respectively). The poorer glycemic control and the longer the duration of the disease, the higher the prevalence of CAN in T2DM. Age, duration of disease, WHR, and HbA1c are well correlated with the severity of CAN. Parasympathetic impairment is more sensitive to the detection of autonomic dysfunctions than do sympathetic impairment.

Background: Fibromyalgia is a syndrome characterized by chronic pain, depression, fatigue, and sleep disturbance. Different hypotheses have emerged about its pathogenesis, but central sensitization, which plays an important role in the development of neuropathic pain, is considered to be the main mechanism. We aim to compare patients with fibromyalgia and healthy controls with different electrodiagnostic testing, and if present, to corroborate whether there is any relationship between electrodiagnostic measures. Also, we sought to test the diagnostic value of some of these measures. Methods: A case-control study of thirty-one patients with fibromyalgia with a duration of illness ranging from 5 months to 10 years were recruited for the study. Full medical history, clinical neurological examination, and electrodiagnostic tests of the upper and lower extremity including nerve conduction studies, needle electromyography, sympathetic skin response, cutaneous silent period and muscle fiber conduction velocity. Results: Sympathetic skin response latency and cutaneous silent period latency were not different between the patients and the control group. Cutaneous silent period duration was prolonged and the muscle fiber conduction velocity is faster in the subjects with fibromyalgia. The latter measures have similar diagnostic value. Sex has no significant impact on electrodiagnostic measures and the latter not correlated with patients' age. Conclusion: A central sensitization and concomitant deregulation of the efferent higher motor centers might be implicated in the pathogenic mechanism of fibromyalgia.

Background: Restless legs syndrome (RLS) manifests as an urge to move the body to relieve the discomfortable sensations, primarily when resting, sitting, laying down, or sleeping. Diagnosis of RLS relies on clinical criteria, and the immobilization test was the only instrumental tool with equivocal results. Objectives: To assess different electrophysiological findings in patients with RLS, and compare the diagnostic values of these parameters in the diagnosis of RLS. Methods: 30 patients with primary RLS and 30 controls who were matched for age and gender were studied. Participant's demographics, laboratory findings, and electrophysiological test, namely nerve conduction studies (NCS), cutaneous silent period (CSP), H reflex and sympathetic skin response (SSR), F-wave latency, amplitude, F-wave duration (FWD), and the ratio between FWD and duration of the cor-responding compound muscle action potential (FWD/CMAPD) were analyzed. Results: None of the patients showed altered NCS data. FWD of upper (12.37 +/- 2.77 ms) and lower limb (21.71 +/- 5.24 ms) were significantly longer in patients. Also, FWD/CMAP duration of the upper (1.03 +/- 0.2) and lower limb (2.02 +/- 0.55) was longer in patients. Likewise, they exhibited delayed CSP latency from TA (110.62 +/- 13.73 ms) and APB (77.35 +/- 12.16 ms) whereas the CSP duration from TA and APB was decreased (37.36 +/- 11.59 ms; 42.55 +/- 7.97 ms, respectively). The SSR latency was not different, and right-sided H reflex amplitude (5.07 +/- 3.98 mV) and H/M ratio (0.65 +/- 1.81) were significantly increased in the patient group. Conclusion: The data suggest that there may be a dysfunction of the inhibitory/excitatory circuits at a spinal level; and no pathology in the peripheral nerves. The unilateral difference of H reflex amplitude and H/M ratio may suggest asymmetrical central inhibitory dysfunction. Further prospective studies with larger cohorts are now needed to evaluate the pathophysiology of RLS with different neurophysiological assessment tools. (c) 2021 Elsevier B.V. All rights reserved.