Evaluating the prevalence and risk factors for depression in patients with temporal lobe epilepsy with hippocampal sclerosis: A cross-sectional multicenter study.

BACKGROUND: Epilepsy frequently accompanies Major Depressive Disorder (MDD). Notably, people with temporal lobe epilepsy and hippocampal sclerosis may face an increased susceptibility to MDD, as evidence indicates the involvement of the limbic system in the development of emotional symptoms. OBJECTIVES: To determine the prevalence and predictors of depression in temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) and compare them to those of other epilepsy types. METHODS: A sample of 293 epilepsy patients, including 159 non-TLE-HS and 134 TLE-HS, were recruited from three hospitals. Of these, 215 completed a two-section electronic survey. The first section collected demographic and epilepsy data, while the second used the Arabic version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). RESULTS: Of 215 patients, 104 (48%) had TLE-HS-38 with right TLE-HS (37%), 56 with left TLE-HS (54%), and 10 with bilateral TLE-HS (10%). The prevalence and severity of depression was assessed with an NDDI-E score of 15 or higher identified 35 patients (16%) with MDD. Valproic acid and lamotrigine were associated with higher NDDI-E scores. No such associations were found for levetiracetam or carbamazepine. Polytherapy in TLE-HS showed a significant correlation with daily poor concentration. CONCLUSION: We explored the differences in depression prevalence between TLE-HS and other epilepsy types and concluded they are minimal but slightly higher in TLE-HS. Predictors of depression such as seizure frequency and disease duration influenced MDD prevalence in TLE-HS. Lamotrigine and valproate were linked to higher NDDI-E scores.

Prevalence and biopsychosocial factors associated with treatment adherence among people with epilepsy in a tertiary care hospital in Riyadh, Saudi Arabia.

OBJECTIVES: To identify the magnitude of treatment adherence among people with epilepsy (PWE) and the impact of sociodemographic, medical and psychosocial factors on treatment adherence. METHODS: A quantitative cross-sectional observational study was performed based on data collected from adult patients attending the epilepsy clinic, King Saud University Medical City, Riyadh, Saudi Arabia. Patients completed paper-based questionnaires including a sociodemographic, cultural, psychiatric history and medical history sections. In addition to that we evaluated treatment adherence by visual-analogue scale (VAS), depressive symptoms by PHQ-9, anxiety symptoms by GAD7, physical symptoms by PHQ-15, attachment style by ECR16 and cognitive impairment by MOCA. RESULTS: A total of 207 patients participated, with a mean age of 34 years;.53.6% were female. The mean patient-reported adherence to their treatment regimen was 81.6%±18.4%. Univariate analysis revealed statistically significant negative associations between depression, anxiety and physical symptoms and treatment adherence. However, multiple linear regression analysis only showed physical symptoms to be a significant predictor for epilepsy medication adherence. CONCLUSION: Somatic (physical) complaints could be important predictors of treatment adherence in (PWE). This study is one of the first to suggest the importance of targeting physical symptoms in screening and intervention approaches to improve Antiepileptic drugs (AEDs) adherence.

Insular epilepsy, an under-recognized seizure semiology. A review for general neurologist.

Understanding seizure semiology is one of the most important and crucial steps in diagnosing a seizure disorder. Insular epilepsy may mimic other focal seizure semiologies, leading to misdiagnosis and failed epilepsy surgery. Insular seizures may begin as brief ictal symptoms, such as laryngeal discomfort and unpleasant throat sensations, and spread rapidly to the temporal or frontal regions, causing prominent ictal symptoms different to the initial insular ictal manifestation. Moreover, insular seizures are associated with complex epileptogenic networks and multiple connections. For this reason, accurate seizure semiology helps to lateralize and localize the seizure onset. The insular cortex is deep, and thus scalp electroencephalography is not always beneficial as the epileptic discharges will not be easily recorded, or they will be seen over other cortical regions like the temporal or frontal areas. Insular surgical resection is generally safe, but it requires extensive presurgical workup and surgical precautions in order to minimize mortality.

The conventional tuning fork as a quantitative tool for vibration threshold.

INTRODUCTION: This study was undertaken to describe a method for quantifying vibration when using a conventional tuning fork (CTF) in comparison to a Rydel-Seiffer tuning fork (RSTF) and to provide reference values. METHODS: Vibration thresholds at index finger and big toe were obtained in 281 participants. Spearman's correlations were performed. Age, weight, and height were analyzed for their covariate effects on vibration threshold. Reference values at the fifth percentile were obtained by quantile regression. RESULTS: The correlation coefficients between CTF and RSTF values at finger/toe were 0.59/0.64 (P = 0.001 for both). Among covariates, only age had a significant effect on vibration threshold. Reference values for CTF at finger/toe for the age groups 20-39 and 40-60 years were 7.4/4.9 and 5.8/4.6 s, respectively. Reference values for RSTF at finger/toe for the age groups 20-39 and 40-60 years were 6.9/5.5 and 6.2/4.7, respectively. DISCUSSION: CTF provides quantitative values that are as good as those provided by RSTF. Age-stratified reference data are provided. Muscle Nerve 57: 49-53, 2018.

Accuracy of seizure semiology obtained from first-time seizure witnesses.

BACKGROUND: Little is known of how accurately a first-time seizure witness can provide reliable details of a semiology. Our goal was to determine how accurately first-time seizure witnesses could identify key elements of an epileptic event that would aid the clinician in diagnosing a seizure. METHODS: A total of 172 participants over 17 years of age, with a mean (sd) of 33.12 (13.2) years and 49.4% female, composed of two groups of community dwelling volunteers, were shown two different seizure videos; one with a focal seizure that generalized (GSV), and the other with a partial seizure that did not generalize (PSV). Participants were first asked about what they thought was the event that had occurred. They then went through a history-taking scenario by an assessor using a battery of pre-determined questions about involvement of major regions: the head, eyes, mouth, upper limbs, lower limbs, or change in consciousness. Further details were then sought about direction of movement in the eyes, upper and lower limbs, the side of limb movements and the type of movements in the upper and lower limbs. Analysis was with descriptive statistics and logistic regression. RESULTS: One hundred twenty-two (71.4%) identified the events as seizure or epilepsy. The accuracy of identifying major areas of involvement ranged from 60 to 89.5%. Horizontal head movements were significantly more recognized in the PSV, while involvement of the eyes, lateralization of arm movement, type of left arm movement, leg involvement, and lateralization of leg movement were significantly more recognized in the GSV. Those shown the GSV were more likely to recognize the event as "seizure" or "epilepsy" than those shown the PSV; 78 (84.8%) vs 44 (55.7%), (OR 0.22, p < 0.0001). Younger age was also associated with correct recognition (OR 0.96, P 0.049). False positive responses ranged from 2.5 to 32.5%. CONCLUSION: First-time witnesses can identify important elements more than by chance alone, and are more likely to associate generalized semiologies with seizures or epilepsy than partial semiologies. However, clinicians still need to navigate the witness's account carefully for additional information since routine questioning could result in a misleading false positive answer.

The Role of Demographic and Symbolic Features in Clinical Arabic Graphesthesia Testing.

OBJECTIVE: Graphesthesia is the ability to identify a symbol traced on the skin. Agraphesthesia is the impairment in this ability and is encountered in various disorders of the somatosensory pathways. We aimed to describe the demographic and symbolic features that influence correct recognition of Arabic graphesthesia stimuli in healthy Arabic individuals. METHODS: Participants were community dwelling healthy Arabian individuals of 18 years of age or older. Demographic information collected included age, gender, years of education, and hand dominance. Assessment was conducted using a list of 15 symbols drawn in a single stroke while the hands were obscured from vision. Symbols were current letters and numbers from Arabic script. Each participant was exposed to 60 attempts in total in a random order and correct responses were counted. RESULTS: A total of 126 male and female participants were included. On average, men scored less than women (p < 0.0001), older subjects scored less than those below 30 years of age (p = 0.03), and higher years of education resulted in higher scores (p = 0.047) while handedness did not significantly associate with performance. More correct responses were seen for numerical symbols than letters (p < 0.0001). Symbols with unique script were more likely to be correctly identified. CONCLUSIONS: Number and letter symbols traced on the palm are identified with varying levels of accuracy when conducted according to our method. Female gender, younger age, and higher education are associated with higher scores. Among the many potential symbolic properties that contribute to recognition, a numeric symbol with a unique script is most likely to be correctly identified.

Multiple sclerosis and myasthenia gravis following severe weight loss.

Weight loss has substantial health benefits, but it is not risk-free. Various neurological disorders have been reported following bariatric surgery-induced weight loss. Here, we report 3 patients who developed multiple sclerosis (MS), one of whom also developed myasthenia gravis (MG), shortly after significant weight loss. Two patients lost weight by following a diet plan and one underwent bariatric surgery. There may be an association between significant weight loss and the development of an autoimmune neurological disorder such as MS or MG; a high index of suspicion is required.

Epilepsy monitoring units in Saudi Arabia: Where do we stand compared to developed countries?

OBJECTIVE: To descriptively assess Epilepsy Monitoring Units (EMUs) and the provided services in Saudi Arabia and compare them based on the geographic region. METHODS: In this cross-sectional study, an electronic questionnaire was emailed to all directors of EMUs in Saudi Arabia from July 2013 to January 2016, with constant updates being made by all respondents throughout the period of data collection. RESULTS: All EMU directors participated. There were 11 EMUs in KSA operating in 8 hospitals; 8 (54.5%) EMUs in Riyadh, 2 (18.2%) in Dammam, 2 (18.2%) in Makkah and 1 (9.1%) in Jeddah. Five (54.5%) EMUs were shared for adults and pediatrics, 3 (27.3%) were devoted to adult patients, and 3 (27.3%) to pediatric patients. The average waiting time was 11 weeks (range: 2-52 weeks). The mean percentage of patients coming from an outside region was 30.6%. The average length of stay was 7 days. Less than 100 patients were monitored annually in 54.5% of the EMUs. Seven EMUs (63.6%) admitted less than 100 patients for seizure characterization. Intracranial monitoring was available in all EMUs. Most EMUs (54.5%) admitted less than 100 patients for pre-surgical workup while 36.4% admitted 100-199, and 9.1% admitted more than 300 patients per year. Epilepsy surgeries were performed for less than 50 patients annually in 81.8% of the hospitals. CONCLUSION: There are 11 EMUs in Saudi Arabia fully equipped to serve epileptic patients. However, they are underutilized considering the number of admitted patient and the number of epilepsy surgeries per year. Also, they are unequally distributed throughout the kingdom.

Epilepsy services in Saudi Arabia. Quantitative assessment and identification of challenges.

OBJECTIVE: To assess the epilepsy services and identify the challenges in hospitals without epilepsy monitoring units (EMUs). In addition, comparisons between governmental and private sectors, as well as between regions, are to be performed. METHODS: A cross sectional study conducted using an online questionnaire distributed to the secondary and tertiary hospitals without EMUs throughout the Kingdom of Saudi Arabia (KSA). The study was conducted from September 2013 to September 2015 and regular updates from all respondents were constantly made. Items in the questionnaire included the region of the institution, the number of pediatric and adult neurologists and neurosurgeons along with their subspecialties, the number of beds in the Neurology Department, whether they provide educational services and have epilepsy clinics and if they refer patients to an EMU or intend to establish one in the future. RESULTS: Forty-three institutions throughout the Kingdom responded, representing a response rate of 54%. The majority of hospitals (58.1%) had no adult epileptologists. A complete lack of pediatric epileptologists was observed in 72.1% of hospitals. Around 39.5% were utilizing beds from internal medicine. Hospitals with an epilepsy clinic represented 34.9% across all regions and sectors. Hospitals with no intention of establishing an EMU represented 53.5%. Hospitals that did not refer their epileptic patients to an EMU represented 30.2%. CONCLUSION: Epilepsy services in KSA hospitals without EMUs are underdeveloped.

Current practice and safety measures in epilepsy monitoring units in the Gulf Cooperation Council Countries: A cross-sectional study.

BACKGROUND: An increasing number of Epilepsy Monitoring Units (EMU) display various practices and safety protocols. EMU settings should meet clear, standardized safety protocols to avoid seizure adverse events (SAE). We aim to provide the foundational framework facilitating the establishment of unified evidence-based safety regulations to address the practices and safety measures implemented within the Gulf Cooperation Council (GCC). METHODS: In this cross-sectional study, EMU directors in the GCC were contacted directly by phone to personally complete an electronic 37-item questionnaire sent via text messages and email. From January 2021-December 2021. RESULTS: Seventeen EMUs from six GCC countries participated in the study. All EMU directors responded to the study. Twelve (70.6%) EMUs monitored adults and children, five (29.4%) monitored adults, and none monitored children only. The number of certified epileptologists in the EMUs ranged from one to eight per unit. Fifteen (88.2%) EMUs applied a continuous observation pattern, whereas two (11.8%) performed daytime only. The precautions most commonly used in the video Electroencephalogram (EEG) were seizure pads and bedside oxygen in 15 EMUs (88.2%). For invasive EEG, seizure pads were used in 9 EMUs (52.9%), %) and IV access in 8 EMUs (47.1%). The occurrence of adverse events varied among EMUs. The most common conditions were postictal psychosis 10 (58.8%), injuries 7 (41.2%), and status epilepticus 6 (35.3%). Falls were mainly related to missed seizures or delayed recognition by video monitors in 8 EMUs (47.1%). The extended EMU stay was because of an insufficient number of recorded seizures in 16 EMUs (94.1%), poor seizure lateralization and localization in 10 (58.8%), and re-introduction of AEDs in nine (52.9%). All EMUs had written acute seizure and status epilepticus management protocols. A postictal psychosis management protocol was available for 10 (58.8%). Medications were withdrawn before admission in 6 EMUs (35.3%). The specific medication withdrawal speed protocol upon admission was available in 7 EMUs (41.2%). Pre-admission withdrawal of medication demonstrated a shorter length of stay in both video and invasive EEG, which was statistically significant (ρ (15) = -.529, p =.029; ρ (7) = -.694, p =.038; respectively). CONCLUSION: The practice and safety regulations of EMUs in the GCC vary widely. Each EMU reported the occurrences of SAE and injuries. Precautions, protective measures, and management protocols must be reassessed to minimize the number of SAEs and increase the safety of the EMU.