Objective: Parkinson’s disease (PD) affects approximately 2% of individuals over the age of 60. With more than two billion Muslims observing Ramadan, individuals with PD encounter specific challenges, such as deteriorating motor skills, sleep disturbances, and an increased risk of falls during fasting. Methods: Our study focused on 75 patients with idiopathic PD divided into two groups: the Ramadan Regime group, which consisted of 50 patients whose medication was adjusted to twice daily at Suhoor and Iftar, and the Nontreatment group, which included 25 patients who abstained from medication for religious reasons. Both groups were instructed to wear a Parkinson’s KinetiGraph (PKG) wrist device. Results: The study findings revealed that motor function worsened in the Nontreatment group (p<0.001) but improved in the Ramadan Regime group (p=0.007). Daytime sleepiness also significantly increased in the Nontreatment group (p<0.001). Conclusion Overall, the findings suggest that the Ramadan regime significantly enhances patient health and quality of life.

Rationale: Guillain Barre syndrome (GBS) is an acute neurological illness leading to quadriparesis with respiratory involvement. It can be triggered by infections, vaccinations, surgery, trauma, transplantation and drugs. Anti-rabies cell culture vaccines introduced to overcome the high rate of neurological complications associated with tissue based rabies vaccine, can be very rarely associated with GBS. Patient concerns: A 50-year-old female presented with acute severe upper back pain evolving into pure motor quadriparesis following administration of human diploid cell vaccine for rabies. Diagnosis: Acute motor axonal neuropathy variant of GBS following anti-rabies human diploid cell vaccine. Interventions: Intravenous high dose steroids. Outcomes: Patient recovered completely within 1 month. Lessons: Although anti-rabies cell culture vaccines are highly immunogenic and safe, they are rarely associated with GBS. Clinicians should be aware of this link because prompt diagnosis and treatment can result in complete recovery and avoid complications.

We report a rare case of a 45 year old female with 15 year history of progressive left facial thinning with frequent episodes of involuntary jaw closure and almost continuous rippling movements over her left sided masticatory muscles. There was localized scleroderma, left facial hemi atrophy and left hemi masticatory spasm. Localized scleroderma was proven histopathologically. Electrophysiological studies revealed normal blink reflex on both sides. Her masseter inhibitory reflex was absent bilaterally and surface electromyogram showed spontaneous bursts of high frequency activity over bilateral masseter and left temporalis muscles. The patient responded remarkably with bilateral botulinum toxin injection. This case highlights presence of rare bilateral involvement of HMS especially on EMG and excellent response to botulinum toxin.

OBJECTIVE: The inability to propel a bolus of food successfully from the posterior part of the oral cavity to the oropharynx is defined as transfer dysphagia. The present case series describes the varied presentation of transfer dysphagia due to focal dystonia and highlights the importance of early detection by following up on strong suspicions. METHODS: We describe seven cases of transfer dysphagia due to focal dystonia. Transfer dysphagia as a form of focal dystonia may appear as the sole presenting complaint or may present with other forms of focal dystonia. RESULTS: Four out of seven patients had pure transfer dysphagia and had previously been treated for functional dysphagia. A high index of suspicion, barium swallow including videofluoroscopy, associated dystonia in other parts of the body and response to drug therapy with trihexyphenidyl/tetrabenazine helped to confirm the diagnosis. CONCLUSION: Awareness of these clinical presentations among neurologists and non-neurologists can facilitate an early diagnosis and prevent unnecessary investigations.
Barium ; Deglutition Disorders ; Diagnosis ; Drug Therapy ; Dystonia ; Dystonic Disorders ; Early Diagnosis ; Humans ; Mouth ; Oropharynx

The presence of anterior hip dislocation along with contralateral posterior hip dislocation in the absence of other major traumas is a distinctly rare injury pattern. We report such a case, along with a review of previous cases. A 40-year-old male patient after motorcycle skidding had posterior dislocation of the left hip and anterior dislocation of the right one without other associated injuries. The patient underwent successful closed reduction of both hips. The clinical course and follow-up assessment of the patient was uneventful.
Hip ; Hip Dislocation ; Humans ; Multiple Trauma

The presence of anterior hip dislocation along with contralateral posterior hip dislocation in the absence of other major traumas is a distinctly rare injury pattern.We report such a case,along with a review of previous cases.A 40-year-old male patient after motorcycle skidding had posterior dislocation of the left hip and anterior dislocation of the right one without other associated injuries.The patient underwent successful closed reduction of both hips.The clinical course and follow-up assessment of the patient was uneventful.