The Spectrum of MRI and Electrographic Findings in Pediatric Patients With Seizures: A Retrospective Tertiary Care Center Study.

Background Seizures constitute a serious public health concern, especially in pediatric patients. They are among the most prevalent medical issues affecting children. Magnetic resonance imaging (MRI) is a widely used imaging modality to evaluate, assess, and follow up on brain abnormalities. Objectives The purpose of the study is to explore the clinical findings of pediatric patients with seizures and their associated findings on MRI examinations. Material and methods A retrospective cohort study was conducted between 2021 and 2022 at King Abdulaziz University Hospital (KAUH). A total of 171 pediatric patients (ages 1-14 years old) who had seizures and underwent brain MRI examinations were included in the study. The mean age of the group was two years. Results Focal seizures represented the majority of seizure types in 62 (60.2%) patients compared to 42 patients who presented with generalized seizures and 67 patients who presented with normal findings based on magnetic resonance imaging (MRI) analysis. The most common finding in imaging was the presence of developmental anomalies, which were found in 31 (18.5%) patients. This was followed by hypoxic-ischemic injury in 12 patients, vascular abnormalities in 10 patients, inherited metabolic disorders in nine patients, and infection-related findings in six patients. Conclusion MRI has an invaluable role in managing pediatric patients with seizures. Accurate diagnosis of patients is an essential step for delivering proper care to patients. MRI is considered the main imaging modality to establish a correct diagnosis and thereby improve prognosis, and electroencephalogram (EEG) should be taken into account during standard neurodiagnostic testing.

Epilepsy awareness among Rabigh Province residents in Saudi Arabia: A cross-sectional survey study.

OBJECTIVES: To investigates the knowledge and attitudes toward epilepsy in Rabigh province in western Saudi Arabia. METHODS: A cross-sectional survey-based study was conducted from July to September 2020. Survey was distributed through the web to Rabigh province general population. Epilepsy awareness score (EAS) was estimated utilizing a generated questionnaire. RESULTS: The number of participants is 511. Most participants did not know what actions to take for an active seizure other than moving the person away from harm (87%). Participants who agreed that epilepsy was highly stigmatized represented 15%. Participants were refusing (27%) or undecided about their reaction (34%) if their child were to marry an epilepsy person (EP). The majority did not mind if their children socialized with EP. Some parents were anxious about having their children play or associated with EP. There are statistically significant associations between EAS and age (p=0.03), monthly income (p=0.03), having children (p=0.04). CONCLUSION: The data found in this study was similar to other Saudi and global studies. Further efforts are needed to strengthen community awareness regarding epilepsy. Stigma in society affects those that are afflicted and has consequences on their loved ones as well. Therefore, supplementary educational campaigns are needed to normalize and create acceptance. Also, to increase awareness regarding first aid of epilepsy.

Body mass index and its association with various features of migraine: A cross-sectional study from Saudi Arabia.

Introduction: Migraine is a highly prevalent condition, and prevalence of obesity is also increasing. Results of studies addressing association of body mass index (BMI) with migraine and its features are conflicting. In this cross-sectional study, we aim to assess association between BMI and various migraine features. Methods: This study was conducted in the Headache Clinic of King Fahd Hospital of University, Al Khobar, Saudi Arabia. Interviews were conducted by three consultant neurologists. Migraine was defined according to the International Headache Society and BMI was calculated as weight (kilograms)/height (m2). Results: Of total of 121 patients, 79% were female. Almost 87.6% of patients were taking prophylactic medications. Majority of patients had attack for more than 24 h (60.3%), pulsating character (81%), moderate-to-severe intensity (92.6%), associated with nausea and/or vomiting (75.2%), and photophobia/phonophobia (91.7%). About 29.8% of patients were normal weight, 28.1% were overweight, and 39.7% were obese and morbidly obese. There was insignificant association between various categories of BMI and features of migraine, that is, unilateral location (P = 0.385), pulsating character (P = 0.571), moderate-to-severe intensity (P = 0.187), nausea and/or vomiting (P = 0.582), and photophobia and/or phonophobia (P = 0.444). Conclusion: In our study, we did not find an association between BMI and various features of migraine.

RésuméIntroduction: La migraine est une maladie très répandue, et la prévalence de l'obésité est également en augmentation. Résultats des études portant sur l'association de l'indice de masse corporelle (IMC) avec la migraine et ses caractéristiques sont contradictoires. Dans cette étude transversale, nous visons à évaluer l'association entre IMC et diverses caractéristiques de la migraine. Méthodes: Cette étude a été menée à la Headache Clinic de l'hôpital King Fahd de l'Université, Al Khobar, Arabie Saoudite. Les entretiens ont été menés par trois neurologues consultants. La migraine a été définie selon l'International La Headache Society et l'IMC ont été calculés en poids (kilogrammes)/taille (m2). Résultats: Sur un total de 121 patients, 79 % étaient des femmes. Presque 87,6 % des patients prenaient des médicaments prophylactiques. La majorité des patients ont eu une attaque pendant plus de 24h (60,3%), caractère pulsatile (81%), intensité modérée à sévère (92,6 %), associée à des nausées et/ou vomissements (75,2 %) et photophobie/phonophobie (91,7 %). Environ 29,8 % des les patients avaient un poids normal, 28,1 % étaient en surpoids et 39,7 % étaient obèses et obèses morbides. Il y avait une association insignifiante entre diverses catégories d'IMC et caractéristiques de la migraine, c'est-à-dire localisation unilatérale (P = 0,385), caractère pulsatile (P = 0,571), modéré à sévère intensité (P = 0,187), nausées et/ou vomissements (P = 0,582) et photophobie et/ou phonophobie (P = 0,444). Conclusion: Dans notre étude, nous n'ont pas trouvé d'association entre l'IMC et diverses caractéristiques de la migraine. Mots-clés: Indice de masse corporelle, fréquence, migraine, obésité, gravité.

The etiology and risk factors of convulsive status epilepticus in pediatric patients of tertiary center in Saudi Arabia.

OBJECTIVES: To assess the etiology of status epilepticus (SE) among the pediatric patients of a tertiary center in Jeddah, Kingdom of Saudi Arabia (KSA). METHODS: Data from 88 cases was obtained retrospectively from 2006 to 2017 from King Abdulaziz University Hospital (KAUH). Patients aged between 28 days and 14 years with the symptoms of SE were selected for this study. RESULTS: The data show that the proportions of SE etiologies were 30.5% for febrile seizure, 11.9% for electrolytes imbalance, 8.5% for hydrocephalus, 6.8% for CNS infections, and 6.8% for neoplasm. The other etiologies of SE were trauma, fever, intractable epilepsy, cerebrovascular accident, hemorrhagic stroke, etc. There were no clear etiologies in 8 cases. Most of the patients were not of Saudi origin (64.3%), boys (67.8%), and had generalized epilepsy types (91.8%), and 58.6% of the patients complied with epilepsy medications. CONCLUSION: The most prevalent etiology of convulsive status epilepticus was a febrile seizure, followed by electrolyte imbalance and hydrocephalus. However, a nationwide study in KSA must be conducted to determine the major etiologies of SE for its effective management and prevention. Educating families and patients regarding antiepileptic drugs is necessary.

The diagnostic yield of the routine EEG at a tertiary care center in Saudi Arabia: A retrospective study.

BACKGROUND: The Routine Electroencephalography (REEG) records cerebral electrical activity to aid in the diagnosis and classification of Epilepsy. Indiscriminate use of the REEG may lower its clinical yield. The pretest clinical variables contributing to the yield of the REEG outcome have not been well-established in the context of developing healthcare systems where REEG utilization may differ from well-established centers. The aim of this study is to determine the yield of the REEG and the pretest clinical variables predicting the yield of the REEG at a single center in the context of the developing healthcare system in Saudi Arabia. MATERIALS AND METHODS: We reviewed REEG reports at a single center in Jeddah, Saudi Arabia between 2015 and 2018. We collected demographic and clinical data from the patients' electronic files. Patients of age ≥18-year-old were included. We collected age, gender, nationality, the indication for the REEG, co-morbidities, antiseizure medicines (ASMs), and details related to the yield of the REEG (normal or abnormal, epileptiform or non-epileptiform, focality, and the presence of rhythmic or periodic patterns or seizures). RESULTS: We included 500 records. Fifty-nine percent were females. The mean age was 39 ±â€¯17 years. Of the recorded REEGs, 42.4% were abnormal, 14.6% of them showing definite epileptiform discharges and 85.4% showing only slowing. Half of the REEGs of individuals previously diagnosed with epilepsy revealed abnormal findings. ASM use was associated with slowing in the REEG (p < .05). Using logistic regression, history of a previous stroke and use of carbamazepine or lamotrigine were predictors of the presence of abnormalities in the REEG, while use of ≥2 ASMs predicted the presence of epileptiform discharges. Stroke also predicted abnormal slowing alongside increased age. CONCLUSION: The clinical yield of the REEG in this sample of patients from a single institution in the context of a developing healthcare system was relatively low. History of stroke and being on more than one ASM may predict that the REEG will show relevant abnormalities.

Treatment of infantile spasms in Saudi Arabia.

OBJECTIVE: To evaluate the treatment approach and compliance of pediatric neurologists with evidence-based guidelines across Kingdom of Saudi Arabia (KSA). These guidelines that clarify the optimal management of infantile spasms (IS) are not widely followed for various practical reasons. METHODS: Physicians practicing in the field of pediatric neurology in KSA were contacted from the database of national societies. A cross-sectional study was conducted using a structured 20-item on-line survey designed to examine their clinical experience with IS and their treatment choices. RESULTS: A total of 52 pediatric neurologists completed the survey (69% estimated capture rate). They received their formal training within KSA (40%), North America (33%), or Europe (14%). The majority practiced in 2 major cities, Riyadh (46%) or Jeddah (19%). Vigabatrin was favored over adrenocorticotropic hormone (ACTH) as first line drug for patients without tuberous sclerosis complex (48% vs. 21%). Several factors correlated with correctly selecting ACTH as first line including western training (33% vs. 5%, p=0.001), practicing in the city of Riyadh (25% vs. 14%, p=0.001), or having >10 years of clinical experience (25% vs. 5%, p=0.017). Reasons for not complying with the recommended treatment guidelines included lack of availability of ACTH (42%), side effect profile of steroids (29%), and personal preferences (14%). Only 4% admitted lack of awareness of the currently published management guidelines. CONCLUSION: Many pediatric neurologists in KSA are not following the published IS management guidelines. Using ACTH as first line correlated with their training, practice location, and years of experience. Lack of drug availability and side effect profile were common reasons for not complying with the management guidelines.