Effectiveness of intra-thecal methotrexate in refractory Anti-N-methyl-d-aspartate receptor encephalitis.

BACKGROUND: Anti-N-methyl-d-aspartate "anti-NMDA" receptor encephalitis is one of the most common autoimmune encephalitis for which first- and second-line therapies have been recommended following international consensus. However, some refractory cases do not respond to the first- and second-line therapy and require further immune-modulatory therapies such as intra-thecal methotrexate. In this study, we reviewed six confirmed cases of refractory anti-NMDA receptor encephalitis from two tertiary centers in Saudi Arabia that required escalation of treatment and received a six-month course of intra-thecal methotrexate. The aim of this study was to evaluate the effectiveness of intra-thecal methotrexate as immunomodulatory therapy for refractory anti-NMDA receptor encephalitis. METHODS: We retrospectively evaluated six confirmed cases of refractory anti-NMDA receptor encephalitis who did not improve after first- and second-line therapy and received monthly intra-thecal methotrexate treatment course for six consecutive months. We reviewed patient demography, underlying etiologies, and compared their modified Rankin score prior to receiving intra-thecal methotrexate and six months after completing the treatment. RESULTS: Three of the six patients showed a marked response to intra-thecal methotrexate with a modified Rankin scale of 0-1 at 6-month follow-up. None of the patients experienced any side effects during or after intra-thecal methotrexate treatment, and no flareups were observed. CONCLUSION: Intra-thecal methotrexate may be a potentially effective and relatively safe escalation option for immunomodulatory therapy of refractory anti-NMDA receptor encephalitis. Future studies on intra-thecal methotrexate -specific treatment regimens may further support its utility, efficacy, and safety in treating refractory anti-NMDA receptor encephalitis.

Public awareness, knowledge, and attitudes regarding epilepsy in the Qassim region, Saudi Arabia.

INTRODUCTION: Epilepsy is a chronic condition and has significant negative consequences to quality of life. Misconceptions regarding epilepsy among communities with lower rates of education have led to false beliefs and ideas. This study aimed to evaluate the awareness, knowledge, and attitudes about epilepsy in Saudi population at Qassim region, Saudi Arabia. METHODS: A cross-sectional study was conducted using a previously validated 14-item questionnaire. The data were collected online via WhatsApp application. The Saudi adult population (18 years and older) within Qassim region was sampled for the present study. RESULTS: A total of 403 respondents completed the survey and the majority (68.8%) were less than 30 years old. Nearly all participants (97.0%) had heard of epilepsy or convulsive seizures; 43.5% knew a person with the disease; and 48.4% had seen a person having a seizure. Participants cited brain disorders (68.1%) as the most common cause of epilepsy, followed by mental disorders (61.9%) then hereditary diseases (48.8%). Only 5.6% would protest against their children associating with a person who occasionally experiences seizures, and a similarly small percentage (7.9%) would do so if their son or daughter decided to marry such a person. CONCLUSION: The public's general attitudes and awareness of epilepsy were quite good; however, knowledge regarding this medical condition is still inadequate. Thus, more campaigns are needed in order to increase societal awareness on epilepsy, obtaining help from governmental agencies, health institutions, mass media, and other health-related organizations.

Prevalence Refractive Errors among Medical Students of Qassim University, Saudi Arabia: Cross-Sectional Descriptive Study.

OBJECTIVE: To study the prevalence of various errors of refraction among the medical students studying at the college of medicine, Qassim University, Saudi Arabia. METHODS: This is a cross-sectional descriptive study conducted at Qassim University clinics over a period of two months. The study population comprised 162 male and female students from different academic years. The students were selected randomly so that around 35-40 students were taken from each academic class. The selected study population was explained the objectives of the study and a written consent form that stated the purpose, methods, risks, benefits, and the assurance of the confidentiality of the data was obtained from each student. After giving the consent, each subject was examined by auto refractometer. The examination was carried out by an optometrist without using cycloplegia. Both right and left eyes were thoroughly examined by auto refractometer and on the average three readings of the refraction measurements were taken. The readings were recorded on a data sheet of every individual, and the Statistical analysis was performed using Statistical Package for Social Sciences (SPSS). RESULTS: One hundred and sixty-two (162) students with a mean age of 22.44 years, Std 1.661 and a range of 8 (19-27) were included in the study. Of the total number, 111 (68.51%) were males and remaining 51 (31.48%) were females. Of the total sample, only 1 (0.617%) student had diabetes mellitus, and 6 (3.70%) students gave a history of previous ocular surgery. Myopia was found to be the commonest error of refraction 53.7% with hyperopia next to it. CONCLUSION: Myopia is found to be a common error of refraction in young adults. A regular checkup is essential to timely correct the error and to prevent deterioration of the vision.