Stroke Unit

Ain Shams university stroke units have been the first stroke units to be established in Egypt and the region and are currently one of the leading and most influential stroke units there.

Vision & Mission
  • To provide the best care for cerebrovascular stroke patients including acute management, diagnosis and secondary prevention.
  • Comprehensive education and training program for undergraduate and postgraduate students

Team

P1010652 P1010313 DSC_0146 Certificate 8c5b9d77-670b-4b89-82cc-afc0d1fc1301 0b1f2827-d5df-4f9c-a860-62e5efd43aa1 2957c8ec-4980-41bb-ad5d-c38b642f60f5 62caa14c-f24b-41e1-9828-64be3b71a9a8 IMG_0091

Education

N/A

Clinical Services

Clinical services:
• Emergency stroke management including intravenous thrombolysis and thromboectomy with state of art protocol 24/7
• Out-patient stroke clinics, stroke rehabilitation services and neurosonology
• Neurovascular intervention unit was established in our department 15 years ago and different procedures are done routinely in both Cardiovascular Hospital and Ain Shams University specialized hospital. The neurovascular intervention is considered a hub for training for different universities across Egypt and the region.
• Tele-stroke started for the first time in Egypt between our unit and Kafr El-sheik hospital in 2019. Also tele stroke is used routinely for consultation and education across Egypt and Africa.
• Neuromodulation lab headed by Professor Dr Nevine El Nahas is state of art lab studying neuroplasticity and the effect of stroke on brain function and different modalities of new neuromodulation techniques after stroke. This lab was established through a grant from the Science and Technology Development Fund (STDF) of the Egyptian Ministry for Scientific Research as a Capacity Building Grant (Instrument acquisition). This opened up unprecedented avenues for clinical research and practice in Egypt as well as Arab region and Africa. Following the STDF initial capacity-building grant, the lab acquired the following assets:

  • Gait and motion lab.
  • A new TMS device.
  • A new cooled rTMS coil (the original one supplied by STDF expired in 2021).
  • Lego press and functional electrical stimulation device.

Community Services

Investigating functional reorganization of brain after injury using navigated transcranial magnetic stimulation (TMS) through which non-invasive brain stimulation can be precisely done while visualizing the subject’s brain through 3D MRI.
Delivering (TMS) while performing EEG analysis to study online perturbations in brain waves in
response to various frequencies of stimulation. This can have an impact on the use of TMS to
induce functional recovery.
Studying brain wave oscillations and change of event related potentials in response to limb movements, speech, sensory or visual stimulation in healthy as well as brain lesioned subjects. This is a preliminary step to be applied for: Brain-Computer interface research
Stroke simulation team was established in 2019 with collaboration of Professor Robert Mikulak, Brno, Czech republic, which is one of the best simulation training center in Europe, and starting simulation training program locally and across the region.

DUTY HOURS IN Neuromodulation Lab:

Tuesday and Wednesday from 9:00 am till 3:00 pm

PATIENTS Services:

  • Inpatient:
    • Cases of any neurological disorder resulting in motor deficit, Ataxia, spasticity aphasia admitted at our neurology department.
    • Cases suspected to have temporal arteritis
  • Outpatient
    • Appointment cases through unit What’s App number
    • Cases referred from other departments inside our hospital
    • Cases referred from our hospital clinics

COMMON  PROCEDURES:

  • Acute Insult Procedures
    • Position in bed.
    • Splints.
    • Physiotherapy plans.
  • Chronic Phase Procedures
    • Constructing long term rehabilitation plans for:
      • Weakness including physiotherapy plans, mirror therapy, functional electric stimulation and constrained induced therapy.
      • Spasticity including Botulinum toxin injections, splints, rTMS and assessing the need for surgery.
      • Ataxia including rTMS and physiotherapy plans.
      • Aphasia and sensory inattention using rTMS.
      • Visual field affection using rTMS.
      • Hemifacial spasm Botulinum toxin injections.

Fellowships and Observerships

N/A

National and International Collaboration

Both stroke units received awards from the European Stroke Organization, and the
World Stroke Organization (WSO).The last awards were in 2020.
Both were certified from the German LGA group in 2019 which is responsible for the
certifications of similar stroke units in Germany.
Both stroke units have more than 3000 patients in SITS registry which is the international registry for stroke from more than 80 countries started since 1996. Professor Hany Aref is the national coordinator for Egypt.

The two stroke units of Ain shams are participating in ENRICH-AF study which is phase III trial and Dr Hany Aref was chosen as the country principal investigator and as a member of the steering committee of the study

International Collaborations for neuromodulation:

EPFL (École Polytechnique Fédérale de Lausanne), Switzerland. LegES: Hybrid Lower Limb Rehabilitation Strategy Using FES-and a Leg-Press Robotic Device.

Histology dep, Ain Shams University and the University of Minnesota: This is an ambitious project and the first of its kind in Egypt where our lab collaborated in a translational neurology effort to create a stroke model in mice then apply

tDCS (a neuromodulation technique) to study its effect on tissue-level. Part of the study is done in Egypt and part in University of Minnesota.

Co-Chairing the AEDES group (Austrian Egyptian Developmental Neurorehabilitation Stewardship) for improving rehabilitation services in university hospital. In collaboration with Peter Lackner, Associate Professor Salzburg University and Slaven Pikija, Associate Professor Medical University of Graz Austria, Christian Doppler Clinic, University Hospital Salzbur, Salzburg, Austria.

UNESCO collaboration among the “Ad Hoc expert group for ethics of Neurotechnology”

Presentation by Nevine El Nahas: “An overview of the draft text of AHEG Recommendation for ethics of Neurotechnology”

Legopress device received from EPFL as part of a project.

UNESCO Ad Hoc expert group for ethics of Neurotechnology

National Collaborations:

Nile University. MD thesis

Cardiology dep. MS thesis

Faculty of Postgraduate Childhood Studies. Ain Shams University. MD thesis

Faculty of Physiotherapy. Cairo Univ. (MD thesis)

The Neurophysiology Chapter of the Egyptian Society of Neurology, Psychiatry and Neurosurgery (conference and workshop)

Publications

  1. El Nahas, N., Elbokl, A. M., Eldayem, E. H. A., Roushdy, T. M., Amin, R. M., Helmy, S. M., Akl, A. Z., Ashour, A. A., Samy, S., Amgad, A., Emara, T. H., Nowara, M., & Kenawy, F. F. (2021). Navigated perilesional transcranial magnetic stimulation can improve post-stroke visual field defect: A double-blind sham-controlled study. Restorative Neurology and Neuroscience, 39(3), 199–207. https://doi.org/10.3233/RNN-211181
  2. El Nahas, N., Roushdy, T. M., Shokri, H. M., Moustafa, R. R., Elsayed, A. M., Amin, R. M., Ashour, A. A., Abd Eldayem, E. H., Elhawary, G. A., & Elbokl, A. M. (2022). Lateralized readiness potentials can identify hemisphere of recovery in stroke patients. Restorative Neurology and Neuroscience, 1–9. https://doi.org/10.3233/rnn-211222
  3. El Nahas, N., Kenawy, F. F., Abd Eldayem, E. H., Roushdy, T. M., Helmy, S. M., Akl, A. Z., Ashour, A. A., Emara, T. H., Moawad, M. M., Amin, R. M., & Elbokl, A. https://doi.org/10.1186/s12984-022-00985-w
  4. Nevine El Nahas, MD, Ahmed El Bokl, MD, Ramez Reda, MD, Eman Hamid, MD, Shady Samy, MD, Hany Aref, MD. CLINICAL RESPONSE TO HIGH FRQUENCY RTMS AMONG PATIENTS WITH INCIDENTAL CEREBRAL SMALL VESSEL DISEASE. Neuromodulation, VOLUME 25, ISSUE 7, SUPPLEMENT , S3. (2022). DOI: 10.1016/j.neurom.2022.08.005
  5. El Nahas, Nevine; Sami, Shady; Aref, Hany; Hamid, Eman; Reda, Ramez; Hazzou, Ahmed; ElBokl, Ahmed; High frequency suprathreshold rTMS to Cz can improve gait apraxia and reduce inflammatory markers in patients with Incidental Cerebral Small Vessel Disease. SSRN Electronic Journal. (2022). Doi. 10.2139/ssrn.4148100
    (2022). Peripheral magnetic theta burst stimulation to muscles can effectively reduce spasticity: a randomized controlled trial. Journal of NeuroEngineering and Rehabilitation, 19(1)
  6. Tamer M. Roushdy, Nevine M. El Nahas, Hany M. Aref, Shady S. Georgy, Amr S. Zaki, Rady Y. Bedros, Hossam M. Shokri., Stroke in the Time of Coronavirus Disease 2019: Experience of Two University Stroke Centers in Egypt, Journal of Stroke 2020;22(2):275 277https://doi.org/10.5853/jos.2020.01550
  7. M Khan, S Al-Rukn, AA Alhazzani, H Aref, T Moreira, N Wahlgren, Changing the face of stroke care in the Middle East North Africa region, Journal of the Neurological Sciences 2020,412, DOI: 10.1016/j.jns.2020.116727
  8. Tamer Roushdy, , Alia H. Mansour, , Heba M. Khafaga, Abdulrahman Sayed, Mohamed Fathy, Salwa Eltawil, , and Tamer Emara, Stroke Patients’ Status Post-Acute Phase of Illness. How Is It and How Ought It to Be: Ain Shams University Experience, Journal of Stroke and Cerebrovascular Diseases, Vol. 28, No. 12 (December), 2019: 104445
  9. NM El Nahas, HM Shokri, TM Roushdy, HM Aref, SM Hamed, AS Shalash, , Urban Versus Rural Egypt: Stroke Risk Factors and Clinical Profile: Cross-Sectional Observational Study, Journal of Stroke and Cerebrovascular Diseases 2019, 28 (11), 104316 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104316
  10. Al-Rukn S, Mazya M, Akhtar N, et al. Stroke in the Middle-East and North Africa: A 2-year prospective observational study of intravenous thrombolysis treatment in the region. Results from the SITS-MENA Registry [published online ahead of print, 2019 Oct 8]. Int J Stroke. 2019;1747493019874729. doi:10.1177/1747493019874729
  11. El Nahas NM, Elbokl AM, Amin RM, et al. Light at the end of the tunnel: Improvement of poststroke visual field defect after open-label navigated perilesional rTMS. Brain Stimul. 2019;12(3):797-799. doi:10.1016/j.brs.2019.01.018
  12. Suhail Al Rukn, Michael V Mazya, Faycal Hentati, Samia Ben Sassi, Fatma Nabli, Zakharia Said, Belahsen Faouzi, Husnain Hashim, Foad Abd-Allah, Benhan Mansouri, Selma Kesraoui, Souheil Gebeily, Husen Abdulrahman, Naveed Akhtar, Niaz Ahmed, Nils Wahlgren, Hany Aref, Mohammed Almekhlafi, Tiago Moreira: Stroke in the Middle-East and North Africa: A 2-year prospective observational study of stroke characteristics in the region-Results from the Safe Implementation of Treatments in Stroke (SITS)-Middle-East and North African (MENA) International Journal of Stroke, 0(0). International Journal of Stroke 03/2019;, DOI:10.1177/1747493019830331
  13. Nevine El Nahas, Hossam Shokri, Osama Abdulghani, Magd Zakaria, Taha Kamel, Nagia Fahmi, Naglaa Khayat, Aly Shalash, Ahmed El Basiony, Ramez Reda, Sherine Farag, Mohamed Tork, Ahmed Elbokl, Ihab Abdelbaset, Hany Aref: Clinical Characteristics of Borderzone Infarction in Egyptian Population. Journal of Stroke and Cerebrovascular Diseases 01/2019;, DOI:10.1016/j.jstrokecerebrovasdis.2019.01.003
  14. Valeria Caso, Magd Fouad Zakaria, Ales Tomek, et al. Improving stroke care across the world: the ANGELS Initiative. CNS 2018: 4:(2). December 2018
  15. Magd Fouad Zakaria, Hany Aref, Azza Abd ElNasser, Nagia Fahmy, Mohamed Amir Tork, Mohamed Mahmoud Fouad, Ahmed ElBokl, Tamer Roushdy, Sara ElFaramawy, Mohammad Abdullah ElShiekh, Ramez Reda Moustafa: Egyptian experience in increasing utilization of reperfusion therapies in acute ischemic stroke. International Journal of Stroke 06/2017; 13(5).,DOI:10.1177/1747493017711949
  16. Magdy A. Mostafa, Lobna M. El-Nabiel, Nagia Aly Fahmy, Hany Aref, Edrees Shreef, Fathy Abd El- Tawab, Osama M. Abdulghany: ACE Gene in Egyptian Ischemic Stroke Patients. Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 07/2016; 25(9)., DOI:10.1016/ j.jstrokecerebrovasdis.2015.05.015
  17. Ramez Reda Moustafa, MD, PhD, MRCP; Amr Abdel Moneim, MD; Haitham Hamdy Salem, MD;Ali Soliman Shalash, MD; Hosam Ahmed Azmy, MD, Intracranial Steno-Occlusive Arterial Disease and its Associations in Egyptian Ischemic Stroke Patients. Stroke.2013;44:538-541. DOI: 10.1161/STROKEAHA.112.679050
  18. Nevine M. El Nahas, Hany M. Aref, Taha K. Alloush, , Nagia A. Fahmy, Khaled A. Ahmed1, Ahmed A. El Basiouny, Mohamed A. Tork, Ahmed M. Elbokl, Hossam M. Shokri. Borderzone Infarction and Small Vessel Disease in a Sample of Egyptian Stroke Patients: Differences and Similarities. Neurol India. Accepted: 05-01-2020
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