Developmental and/or epileptic encephalopathy with spike-and-wave activation in sleep in Saudi Arabia: Electroclinical, etiologic, genetic, and outcome multicenter study.

OBJECTIVES: To investigate the clinical features of developmental and/or epileptic encephalopathy with spike-and-wave activation in sleep (D/EE-SWAS), its electrographic characteristics, and etiology and to compare the effects of different treatment strategies on the outcomes using a Saudi Arabian database. METHODS: This multicenter study included children with D/EE-SWAS who were evaluated between 2010 and 2020 at 11 tertiary centers. Data were collected on their baseline clinical features, etiologies, and treatment modalities. Seizure reduction, spike-wave index, and cognitive state were examined as potential therapeutic outcomes. RESULTS: Ninety-one children were diagnosed with D/EE-SWAS, with a median age of 7 years (IQR: 3-5) and an almost equal sex distribution. The average age at which epilepsy was diagnosed was 3 years (IQR: 5-2). A genetic/metabolic etiology was found in 35.1% of the patients, and a structural etiology was found in 27.4%. Children with underlying genetic/metabolic diseases exhibited an earlier seizure onset (P = 0.001) than children with other etiologies. Benzodiazepines (76.6%) were the most common treatment, followed by steroids (51.9%). Sodium valproate (75%) was the most frequently used antiseizure medication, followed by levetiracetam (64.9%). Children with a later seizure onset were more likely to have better clinical responses (P = 0.046), EEG responses (P = 0.012), and cognitive outcomes (P = 0.006) than children with an earlier onset. Moreover, better seizure response and electrographic response were seen in patients with bilateral interictal discharges on the EEG than otherwise. Children had a higher likelihood of both clinical and electrographic improvement with combination therapy of benzodiazepines (P = 0.001) and steroids (P = 0.001) than with other therapies. SIGNIFICANCE: This study shows a higher prevalence of genetic/metabolic causes and suggests the superior efficacy of combination therapy with steroids and benzodiazepines in D/EE-SWAS. Prospective studies that strictly assess the treatment protocols and outcomes are needed.

Relationship between body functions and Arabic handwriting performance at different acquisition stages.

BACKGROUND.: The written languages and handwriting acquisition stages place different demands on the writer. Therefore, the relationship between body functions and handwriting performance may vary in different languages and acquisition stages; yet these demands have not been studied in the Arabic language. PURPOSE.: We examined the relationship between linguistic, visual-motor integration (VMI), and motor coordination (MC) functions and Arabic handwriting at two handwriting acquisition stages. METHOD.: This study used a cross-sectional and correlative design. Second- ( n = 54) and fourth-grade ( n = 59) students performed tasks examining reading, handwriting automaticity, VMI, MC, and copying a text. FINDINGS.: Handwriting automaticity significantly explained the variance in handwriting speed in both grades, in addition to the VMI in second grade and the MC in fourth grade. Enhanced performance in the VMI increased the likelihood of having good legibility in second but not in fourth grade. IMPLICATIONS.: Similar to other languages, the body functions related to Arabic handwriting vary at the different acquisition stages. Handwriting evaluation should be adjusted to students' acquisition stage.