Botulinum toxin injection in the management of chronic migraine: the Saudi experience with a proposal for a new protocol.

There are no data from Saudi Arabia about the use of botulinum toxin for migraine prevention. In this article, we aim to study the clinical profile, safety, and response to treatment with botulinum toxin injection for migraine patients. In addition, we aim to share our experience with the use of botulinum toxin modified injection protocol (5/20/100 protocol) in the management of migraine in Saudi patients. A retrospective single-center observational study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The protocol for botulinum toxin injection for migraine in our hospital consisted of injecting five muscles with a total of 20 injection sites consuming 100 units of Onabotulinumtoxin A (BOTOX®, Allergan, Inc., Irvine, CA). A total of 30 patients were included in our study. The mean frequency of migraine days showed a significant reduction from baseline at 15.61 ± 10.92 days per month to 6.14 ± 6.16 days (9.47 days reduction) after botulinum toxin injection (39.3% reduction; paired t test = 5.177; p = 0.0001). The frequency of using abortive medications was reduced in 19 patients (63.3%). Only four patients (13.3%) achieved a headache-free status. Only three patients (10%) had adverse events from botulinum toxin injection. In conclusion, botulinum toxin is an effective, safe, and well-tolerated treatment option for the prevention of chronic migraine. Our protocol (5/20/100 protocol) may improve the safety and cost and reduce the incidence of adverse events. Patients who do not respond to our protocol may switch to the standard protocol after the failure of the first treatment session.

Perception and attitude of the general population towards Alzheimer's disease in Jeddah, Saudi Arabia.

There are many conflicting beliefs about Alzheimer's disease in the general population. Conducting a study on public awareness, attitude, and knowledge towards Alzheimer's disease is useful in decreasing discrimination and stigmatization. This study aims to determine the public perception and attitude towards Alzheimer's disease in Jeddah, Saudi Arabia. In addition, we aim to identify the religious and cultural beliefs about the causes and treatment of Alzheimer's disease in Saudi Arabia. This is a cross-sectional study that was conducted in malls and public places in Jeddah, Saudi Arabia. The instrument used in this study was a self-administered questionnaire that consists of 40 items. A total of 32 questions were included into the survey, which was subdivided into four sources of information that include general information about Alzheimer's disease, information about Alzheimer's disease in the society, general information about persons with Alzheimer's disease, and information about the care of persons with Alzheimer's disease. In addition, eight questions were used to collect information about the demographic profile of the participants. A total of 1698 individuals participated in the study. 1511 participants (89%) had heard about Alzheimer's disease before. Around 46% of the participants think that the cause of Alzheimer's disease is a brain disease and 44.9% think that is a normal part of aging. Approximately, 30% of the participants believe that Alzheimer's disease is treated with medications and 24.6% believe that there is no treatment. Around 30% of the participant think that the society treats persons with Alzheimer's disease with stigmatization. More than half of the participants (56.2%) think that persons with Alzheimer's disease should not be admitted to the nursing home. The results of the present study suggest that the perception of the general public of Alzheimer's disease is lagging behind. Many wrong beliefs were identified in the general public regarding the causes and management. The findings of our study suggest that more information about Alzheimer's disease would be valuable and beneficial for everyone. Awareness campaigns and public education are needed to increase the knowledge of the general public regarding several aspects of the disease including prevention, causes, and management. Dissemination of information about Alzheimer's disease should be of high priority. Increased awareness will lead to earlier detection of Alzheimer's disease and other dementia cases and appropriate care and management of those persons.