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MicroRNAs (miRNAs) are a class of short, non-coding, regulatory RNA molecules that function as post transcriptional regulators of gene expression. Altered expression of multiple miRNAs was found to be extensively involved in the pathogenesis of different neurological disorders including Alzheimer’s disease, Parkinson’s disease, stroke, epilepsy, multiple sclerosis, amyotrophic lateral sclerosis, and Huntington’s disease. miRNAs are implicated in the pathogenesis of excitotoxicity, apoptosis, oxidative stress, inflammation, neurogenesis, angiogenesis, and blood–brain barrier protection. Consequently, miRNAs can serve as biomarkers for different neurological disorders. In recent years, advances in the miRNA field led to identification of potentially novel prospects in the development of new therapies for incurable CNS disorders. MiRNA-based therapeutics include miRNA mimics and inhibitors that can decrease or increase the expression of target genes. Better understanding of the mechanisms by which miRNAs are implicated in the pathogenesis of neurological disorders may provide novel targets to researchers for innovative therapeutic strategies.

Abstract Objectives To assess risk factors for persistent neuropathic pain in subjects recovered from coronavirus disease 2019 (COVID-19) and to study the serum level of neurofilament light chain (NFL) in those patients. Design Case-control study. Setting Persistent post-COVID-19 pain. Subjects In total, 45 patients with post-COVID-19 pain and another 45 age and sex-matched healthcare workers who recovered from COVID-19 without pain. Methods The included participants were subjected to medical history taking, screening for depressive disorders, comprehensive neurological examination, and pain evaluation using the Douleur Neuropathique en 4 questions (DN4). All patients who had a score at least 4/10 on DN4 were included. The serum NFL level was measured for both groups at the time of patients’ enrollment. Results The frequency of depression, moderate and severe COVID-19 cases, disease duration and serum ferritin were significantly higher in the cases with post-COVID-19 pain than controls. Binary logistic regression revealed that depression, azithromycin use, moderate and severe COVID-19 increased the odds of post-COVID-19 pain by 4.462, 5.444, 4.901, and 6.276 times, respectively. Cases with post-COVID-19 pain had significantly higher NFL (11.34 ± 9.7, 95% confidence interval [CI]: 8.42–14.25) than control group (7.64 ± 5.40, 95% CI: 6.02–9.27), (P value = .029). Patients with allodynia had significantly higher NFL (14.96 ± 12.41, 95% CI: 8.58–21.35) compared to those without (9.14 ± 6.99, 95% CI: 6.43–11.85) (P value = .05). Discussion Depression, azithromycin, and moderate and severe COVID-19 are independent predictors of persistent post-COVID-19 pain. Serum NFL may serve as a potential biomarker for persistent neuropathic pain after COVID-19.

Introduction Medical students face a unique set of challenges, including high academic stress, irregular schedules, and clinical responsibilities, which place them at increased risk for sleep disturbance, particularly insomnia. Methods This study aimed to assess the prevalence of insomnia using the DSM-5-TR core symptoms, evaluate sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and investigate the use and safety of sleep aid medications in this population. A cross-sectional survey was conducted among 1,640 Kasr Al Ainy medical students, Cairo, Egypt. Data collected included demographic characteristics, medical history, insomnia symptoms, and PSQI scoring. Sleep aid utilization, including off-label use of medications like quetiapine, was specifically examined. Results The mean age of participants was 20.53 ± 2.08 years, with 58.7% being female. A total of 80% reported at least one insomnia symptom, and 93.7% had poor sleep quality (PSQI ≥ 5). Psychiatric conditions were reported by 29.2% of participants, significantly more common among females ( p  < 0.001). Although 259 participants were taking medications with sedative properties, only 8.8% sought medical advice for insomnia and just 157 explicitly reported using sleep aids. Melatonin was the most used ( n  = 121), followed by herbals, eszopiclone, and diphenhydramine. Seventeen participants reported using quetiapine, of whom 13 (76.5%) experienced adverse effects. Among the 12 participants who reported on its effectiveness, 5 (41.7%) perceived it as having limited efficacy. Conclusion This study reveals the burden of sleep disturbance among medical students, with a major gap between the prevalence of insomnia and the utilization of professional sleep interventions. The off-label use of quetiapine, even among a small subset of our sample, raises notable safety concerns. This finding serves as an important pharmacovigilance signal and underscores the need for further investigation into the risks associated with this potentially hazardous practice. Non-pharmacological strategies such as sleep hygiene education and cognitive-behavioral interventions are needed.

Background & objectives Studying comorbidities with migraine aids in a better understanding of its pathophysiology and potential therapeutic targets. This case-control study aimed to study the impact of insulin resistance and metabolic syndrome on the characteristics of migraine headache attacks. Methods A case-control study was conducted on 30 migraine patients and 30 healthy controls. The following data were assessed in migraine patients: type of migraine, duration of attacks, Migraine Severity Scale (MIGSEV), and Headache Impact Test-6 (HIT-6). Both groups were assessed for waist circumference and underwent the following tests: fasting blood glucose, fasting insulin, high-density lipoprotein cholesterol level, and triglycerides, and homeostasis model assessment–insulin resistance (HOMA-IR) was applied. Results This study included age and sex-matched patients and controls. Migraine patients had significantly higher waist circumference, higher mean values of serum insulin, HOMA-IR and higher frequency of insulin resistance and metabolic syndrome than the control group ( P -value = 0.005, 0.049, 0.01, 0.012, 0.024, respectively). Migraine patients with insulin resistance had significantly higher intensity and tolerability scores, MIGSEV total score, and HIT-6 total score compared to those without ( P -value = 0.005, 0.005, 0.002, 0.018, respectively). There was a significantly positive correlation between the MIGSEV and HIT-6 scores and fasting insulin levels, and HOMA-IR value ( P -value = 0.006, ≤ 0.001, 0.017, ≤ 0.001, respectively). Conclusion Insulin resistance and metabolic syndrome are more common in migraine patients than in healthy controls. The severity and impact of migraine attacks are higher in patients with insulin resistance than in those without.

Background & Objectives Objective assessment of post-COVID-19 cognitive dysfunction is highly warranted. This study aimed to evaluate the cognitive dysfunction of COVID-19 survivors with cognitive complaints, both clinically and neurophysiologically, using Quantitative Electroencephalogram (QEEG). Methods This case–control study was conducted on 50 recovered subjects from COVID-19 infection with cognitive complaints and 50 age, sex, and educational-matched healthy controls. Both groups were subjected to the following neurocognitive tests: Paired associate learning Test (PALT) and Paced Auditory Serial Addition Test (PASAT). The neurophysiological assessment was also done for both groups using QEEG. Results COVID-19 survivors had significantly lower PALT scores than controls ( P  < 0.001). QEEG analysis found significantly higher levels of Theta / Beta ratio in both central and parietal areas in patients than in the controls ( P  < 0.001 for each). The interhemispheric coherence for the frontal, central, and parietal regions was also significantly lower in patients than in the control group regarding alpha and beta bands. There were statistically significant lower scores of PALT and PASAT among cases with severe COVID-19 infection ( P  =  0.011, 0.005 , respectively) and those who needed oxygen support ( P  = 0.04, 0.01, respectively). On the other hand, a statistically significantly lower mean of frontal alpha inter-hemispheric coherence among patients with severe COVID-19 infection ( P  = 0.01) and those needing mechanical ventilation support ( P  = 0.04). Conclusion Episodic memory deficit is evident in COVID-19 survivors with subjective cognitive complaints accompanied by lower inter-hemispheric coherence in frontal regions. These clinical and neurophysiological changes are associated with hypoxia and COVID-19 severity.

Background Clinical evaluation of cluster headache (CH) impact on patients’ quality of life is crucial in research and clinical practice. To our knowledge, none of the measures that evaluated CH-related disability were validated in Arabic. This study aimed to evaluate the reliability and validity of the Arabic version of Cluster Headache Impact Questionnaire (CHIQ) in both active episodic CH (eCH) and chronic CH (cCH). Methods Patients with active eCH or cCH were requested to answer the Arabic version of CHIQ, Depression, anxiety and stress scale– 12 (DASS-12), and Short form-12 health survey (SF-12). Cronbach’s α and intraclass correlation coefficient (ICC) were used to assess the test reliability. Convergent validity and Explanatory factor analysis of CHIQ items were also assessed. Results Seventy-two patients with active eCH and another 16 with cCH were evaluated. Patients with cCH had a significantly higher median value of CHIQ total score in comparison to those with eCH (P-value < 0.001). No ceiling or floor effects were detected in CHIQ total score. The Arabic version of CHIQ showed excellent reliability (Cronbach’s α = 0.901). The intraclass correlation coefficient of CHIQ total score was 0.983 indicating excellent test re-test reliability. The CHIQ scores were significantly correlated with scores of DASS-12 ( r  = 0.477) and SF-12 ( r =-0.691), supporting the convergent validity of the scale. Exploratory factor analysis revealed two factors labelled as “physical and cognitive impact” and “psychological impact” factors. Conclusion Arabic version CHIQ is a reliable and valid tool for measuring CH-related disability and quality of life in patients with eCH and cCH.

BACKGROUND: The mechanism of pain control with pulsed radiofrequency (PRF) is unclear. OBJECTIVES: We aimed to compare the efficacy of combined PRF on dorsal root ganglion (DRG) with transforaminal epidural steroid injection (TFESI) vs TFESI-alone on pain improvement and serum tumor necrosis factor-alpha (TNF-a) level in lumbar disc-related radicular pain. STUDY DESIGN: Prospective, randomized, controlled trial. SETTING: Neurology and Pain Management clinics. METHODS: A total of 80 patients with lumbar disc prolapse were divided into 2 groups: combined PRF on DRG with TFESI group and TFESI-alone group. The Numeric Rating Scale (NRS-11), Oswestry Disability Index (ODI), and Functional Rating Index (FRI) before intervention and at 2 weeks, 1 month, and 3 months after the intervention were observed. Serum TNF-a level was assessed pre- and post-intervention at 3 months. RESULTS: The scores of NRS-11, ODI, and FRI showed a significant improvement at 2 weeks, 1 month, and 3 months following intervention in both combined PRF & TFESI group and TFESI-alone group (P < 0.001 in all comparisons), with no significant difference between the 2 groups. Serum TNF-a levels showed a statistically significant reduction, 3 months following intervention in the combined PRF & TFESI group (P < 0.001), but not in the TFESI-alone group (P = 0.297) (P between groups < 0.001). LIMITATIONS: The main limitation of this study is that TNF-a level was not assessed earlier to see how long the steroids might reduce TNF-a. On the other hand, further study with extended follow-up periods is needed to confirm the long-term lowering effect of TNF-a provided by PRF. CONCLUSIONS: Combined PRF on DRG with TFESI showed similar outcomes to TFESI-alone in relieving pain in patients with lumbar disc prolapse. However, PRF on DRG caused a significant decrease in TNF-a serum levels at 3 months. KEY WORDS: Pulsed radiofrequency, transforaminal steroids injection, tumor necrotic factor-alpha, lumbar disc prolapse

Background Determining the cause of visual deterioration in idiopathic intracranial hypertension (IIH) patients is of clinical necessity. This study aimed to study the effect of chronic increased ICP on the retina and optic nerve through objective electrophysiological measures in chronic IIH patients. Methods Thirty patients with chronic IIH and thirty age and sex-matched healthy controls were included in this study. Papilledema grade and CSF pressure were evaluated in the patients’ group. Both groups were submitted to visual evoked potentials (VEP) and multifocal electroretinogram (mfERG). Result The mean value of P100 latencies of the right and left on two check sizes, 1 deg and 15ṁ in chronic IIH patients, was significantly delayed than controls (P-value < 0.001 for each). Chronic IIH patients showed a significantly lower amplitude of the right and left R1, R2, R3, R4 & R5 compared to controls (P-value < 0.001, < 0.001) (P-value < 0.001, < 0.001) (P-value < 0.001, < 0.001) (P-value < 0.001, = 0.001) (P-value = 0.002, < 0.001), respectively. Also, patients showed a significantly delayed peak time of the right and left R1 and R2 compared to controls (P-value < 0.001, < 0.001) (P-value = 0.001, = 0.009), respectively. There was a significant positive correlation between each of CSF pressure and papilledema grade with right and left PVEP latencies. In contrast, there was no statistically significant correlation between either CSF pressure or papilledema grade and PVEP amplitudes in both eyes. Conclusion In chronic IIH patients, both optic nerve dysfunction and central retinal changes were identified, supported by VEP and the mfERG findings.

BackgroundBell’s palsy is common neurological disease. It is treated mainly by steroids with different physiotherapy (PT) modalities such as electrical stimulation, massage, exercise, and infrared. Low-level laser therapy (LLLT) also showed promising results. In this study, we aimed to investigate relevant factors related to the patients, disease, and treatment to explore their prognostic values in Egyptian patients. ResultsThe age ranged from 24 to 50, with a median of 39. Two (1.4%) patients were pregnant. Hypertension (HTN) was the most common comorbidity found in 49.3%, followed by diabetes mellitus (DM) then ischemic heart disease (IHD). Around 98.6% of cases had unilateral palsy. The majority (81.2%) of cases were treated with steroids, and around 50% of cases received added-on laser physiotherapy. Around two-thirds (65.9%) of cases had a favorable outcome. Old age, DM, hepatic disorder, and pregnancy were associated with poor recovery, while steroids and laser therapy were associated with good outcomes. The regression model revealed that treatment with steroids and laser therapy increased the odds of favorable outcome by 4.317 (CI: 1.533–12.157) and 2.238 (CI: 1.019–4.915) times, respectively.ConclusionsOld age, comorbid diseases, and pregnancy worsen the prognosis. However, steroid and laser physiotherapy improve outcomes and better recovery.

Background Specific dietary recommendations for migraine patients with comorbid irritable bowel syndrome (IBS) are lacking. This work aimed to study the severity scores of such two common pain-related disorders in relation to various macronutrients and micronutrients intake. Methods A cross-sectional study was conducted on patients with concomitant migraine and IBS. The frequency and intensity of migraine attacks and the severity of IBS were evaluated. Data on dietary intake were collected using food frequency questionnaires and 24-hour dietary recall. Results One-hundred patients with a median age of 36 years participated. The severity scores for migraine and IBS were positively correlated with fat and copper and negatively correlated with fiber and zinc intake. Copper intake was an independent predictor of the severity of both migraine and IBS (P 0.033, < 0.001). Patients with episodic migraine ( n =  69) had a significantly higher frequency of cooked, fresh vegetables, and wheat bran bread intake (P 0.009, 0.004, 0.021) and lower frequency of hydrogenated oils intake (P 0.046), in comparison to patients with chronic migraine ( n =  31). Patients with moderate intensity of migraine ( n =  37) had a significantly higher frequency of herbal drinks intake (P 0.014) than patients with a severe intensity of migraine ( n =  63). Patients with mild ( n =  13) and moderate IBS ( n =  41) had a significantly higher frequency of wheat bran bread and sen bread intake (P 0.003, 0.022) than patients with severe IBS ( n =  46). Conclusion Patients with comorbid migraine and IBS are advised to adhere to a diet low in fat and copper and rich in fiber and zinc.