Evaluating Saudi Parental Interagency on Collaborative Initiatives for Successful Post-Secondary Transition of Students with Intellectual Disabilities.

Effective collaboration between schools and community agencies is paramount for the successful transition of students with disabilities to post-secondary educational settings. This study, conducted in Riyadh, Saudi Arabia, focuses on assessing the level of collaboration from the perspective of parents of students with intellectual disabilities. Using descriptive analysis, data was gathered from 191 parents, and the results indicate a perceived low level of collaboration between schools and various agencies in planning and supporting the transition to post-secondary environments. The study results evaluate collaboration in three dimensions: (a) universities rank lowest with x¯ =1.61 and SD=1.102). (b) vocational training centers ranking highest (1st rank) with an x¯ = 1.97 and SD = 1.079), and (c) other relevant service centers 2nd rank with x¯ =1.69 and SD= 1.177. The findings emphasize the necessity for legislative measures directing agencies to engage in collaborative agreements with secondary schools. This proactive approach aims to enhance opportunities for students with intellectual disabilities during their transition to post-secondary education and training. The study concludes with implications for future research and recommendations for fostering improved collaboration and support mechanisms.

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.

Factors affecting the attitudes of principals of saudi general education public schools toward the inclusion of students with disabilities.

BACKGROUND: Research has indicated that the attitudes of principals toward students with disabilities may affect the success of the implementation of inclusive programs in schools. This study was designed to address a gap in the research regarding Saudi principals' attitudes toward inclusion. Relationships between attitudes and a number of variables were analyzed (i.e., gender, years of experience, level of school, type of student disability, personal relationships with individuals with disabilities). METHODS AND PROCEDURE: The study sample was drawn from the 600 public general education elementary, middle, and high schools with special education programs in Riyadh (n = 366 schools) and Jeddah (n = 234 schools) in Saudi Arabia. Each of the principals of these schools for AY2022/2023 was sent an email invitation to participate. A total of 403 respondents (67.17% response rate) successfully completed Bailey's (2004) Principals' Attitudes Toward Inclusive Education (PATIE) scale via electronic survey link. RESULTS AND OUTCOMES: Overall, the research found that Saudi principals of public general education schools have positive attitudes toward inclusion. The factors of training in special education, personal experience with individuals with disabilities, and years of experience as principal were found to be significant in regard to more positive attitudes. Conversely, the variables of gender, level of school, and type of student disability were not found to correlate with more or less positive attitudes. CONCLUSIONS AND IMPLICATIONS: While the findings of the study bode well for the implementation of inclusion in Saudi public schools, certain limitations exist, including that the study sample was entirely drawn from the two largest cities in the country. In addition, the Saudi Ministry of Education has created an incentive plan that provides financial bonuses to principals at public schools who implement inclusive and special education programming in their schools. This indicates that the target population of this study might be more inclined to be positive toward inclusion than their colleagues at private schools. The findings have implications for expanding special education training in university teacher education programs and the creation of public awareness programs designed to improve understanding of disabilities and how inclusion positively impacts society as a whole.

Association Between Magnetoencephalography-Localized Epileptogenic Zone, Surgical Resection Volume, and Postsurgical Seizure Outcome.

PURPOSE: Surgical resection of magnetoencephalography (MEG) dipole clusters, reconstructed from interictal epileptiform discharges, is associated with favorable seizure outcomes. However, the relation of MEG cluster resection to the surgical resection volume is not known nor is it clear whether this association is direct and causal, or it may be mediated by the resection volume or other predictive factors. This study aims to clarify these open questions and assess the diagnostic accuracy of MEG in our center. METHODS: We performed a retrospective cohort study of 68 patients with drug-resistant epilepsy who underwent MEG followed by resective epilepsy surgery and had at least 12 months of postsurgical follow-up. RESULTS: Good seizure outcomes were associated with monofocal localization (χ2 = 6.94, P = 0.001; diagnostic odds ratio = 10.2) and complete resection of MEG clusters (χ2 = 22.1, P < 0.001; diagnostic odds ratio = 42.5). Resection volumes in patients with and without removal of MEG clusters were not significantly different (t = 0.18, P = 0.86; removed: M = 20,118 mm3, SD = 10,257; not removed: M = 19,566 mm3, SD = 10,703). Logistic regression showed that removal of MEG clusters predicts seizure-free outcome independent of the resection volume and other prognostic factors (P < 0.001). CONCLUSIONS: Complete resection of MEG clusters leads to favorable seizure outcomes without affecting the volume of surgical resection and independent of other prognostic factors. MEG can localize the epileptogenic zone with high accuracy. MEG interictal epileptiform discharges mapping should be used whenever feasible to improve postsurgical seizure outcomes.

Psychometric properties of principals' attitudes toward inclusive education (PATIE) scale: Arabic version.

BACKGROUND: Inclusive education is critical for the successful integration of students with disabilities into general education schools, and principals' attitudes play a crucial role in this process. Despite the recognized significance of attitudes, there remains a gap in understanding these attitudes among principals in Arabic-speaking regions concerning inclusive education practices. This study aims to bridge this gap by validating and assessing the reliability of the Arabic version of the Principals' Attitudes Toward Inclusive Education (PATIE) scale. METHODS: To measure these attitudes in the Arab region, the current study validated and assessed the reliability of the Arabic version of the Principals' Attitudes Toward Inclusive Education (PATIE) scale using a sample of 391 principals from schools that have in place inclusion programs for students with disabilities. Confirmatory factor analysis (CFA) was employed to validate the scale's structural, discriminant, and convergent validity, while Cronbach's alpha and composite reliability (CR) were utilized to evaluate the scale's reliability. RESULTS: The results demonstrated the strong validity and reliability of the Arabic version of the PATIE, with all five factors displaying good reliability. CONCLUSIONS: These findings suggest that the scale can effectively measure attitudes toward inclusive education in Arabic-speaking countries. This study's implications for research and practice are significant, as they underscore the importance of positive attitudes among principals in promoting inclusive education and provide a validated tool for measuring these attitudes.

A step toward autonomy in education: probing into the effects of practicing self-assessment, resilience, and creativity in task supported language learning.

Self-assessment (SA) can provide students with opportunities to self-evaluate, or make judgments about their learning process and products of learning. Regarding the importance of SA, this survey pursued to examine the effects of practicing SA on Saudi Arabian EFL learners' resilience, creativity, and autonomy in task supported language learning. To fulfill these objectives, 60 intermediate EFL learners were chosen and separated accidentally into two groups of control and experimental. They were then pre-tested using three related questionnaires of resilience, creativity, and autonomy. Next, the treatment was practiced on the two groups. Eight lessons of Touchstone Book 3 were taught to the experimental group using SAvia applying different tasks. On the other hand, the lessons were trained to the control group without using SA and tasks. The aforementioned questionnaires were re-administered as the post-tests following the completion of all lessons. Independent and paired samples t-test findings displayed that the control and experimental groups performed differently on the three post-tests. In essence, the results showed that the experimental group's resilience, creativity, and autonomy were all improved by the treatment. The research's implications and conclusions were then outlined. The implications of the research can allow students to evaluate their own progress and skill development critically.

Health related quality of life in a Saudi population of patients with epilepsy.

OBJECTIVES: To assess the quality of life for epilepsy patients in Saudi Arabia. Epilepsy, one of the most prevalent chronic neurological conditions in the world, frequently results in a low quality of life. METHODS: This cross-sectional study analyzed data between September 2020 and September 2021 from 102 adult patients with epilepsy in outpatient clinics department of Epilepsy Program at King Fahad Medical City compared it to 108 healthy controls during the same study period. Sociodemographics and clinical data were gathered using the Arabic version of the Rand 36-Item Short Form Survey (SF-36) questionnaire and the Quality of Life in Epilepsy Inventory (QOLIE-31). RESULTS: Patients with epilepsy had lower SF-36 scores when compared to the control for role limitation due to physical health, role limitations due to emotional health, and general health. The QOLIE-31 revealed that gender was associated with energy/fatigue (p=0.028), medication effect (p=0.016), and social function (p=0.003); only social functioning showed a significant association (p=0.023) with employment. CONCLUSION: Quality of life for patients with epilepsy was found to be significantly impacted in Saudi Arabia. Certain factors found in this study differentiate it from data that has already been released. This might be due to Arab differences in family support as well as cultural and religious beliefs.

Sleep quality, daytime sleepiness, and insomnia in patient with epilepsy: A single center experience from Saudi Arabia.

OBJECTIVES: To measure the burden of insomnia and daytime sleepiness (DTS) and their effects on sleep quality, and the risk factors of poor quality of sleep. METHODS: We conducted a cross-sectional study of 218 epilepsy patients. We administered well-validated and previously translated questionnaires to assess sleep quality, insomnia, and DTS using the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale, respectively. RESULTS: Approximately 75% of participants reported poor sleep quality. Moreover, 42.2% did not have insomnia, while 37.6%, 17.9%, and 2.3% had subthreshold insomnia and clinical insomnia of moderate and severe severity, respectively. Roughly 64.2% of participants had normal sleep, 17.8% had an average amount of DTS, and 16.9% and 0.9% may and should seek medical attention, respectively. Compared to normal sleepers, patients with clinical insomnia were 5.45 times likely to experience poor sleep quality, whereas patients with an average amount of DTS and who were recommended to seek medical attention were 6.84 and 44.15 times likely to experience poor sleep quality, respectively. Patients who had seizures every month were 2.51 times likely to experience poor quality sleep, compared to patients who had seizures annually. CONCLUSION: We found a higher prevalence of poor quality of sleep, insomnia, and excessive DTS in our sample of Saudi epilepsy patients.

Clinical significance of ictal magnetoencephalography in patients undergoing epilepsy surgery.

OBJECTIVE: The significance of ictal magnetoencephalography (MEG) is not well appreciated. We evaluated the relationships between ictal MEG, MRI, intracranial electroencephalography (ICEEG), surgery and postoperative seizure outcome. METHODS: A total of 45 patients (46 cases) with ictal MEG who underwent epilepsy surgery was included. We examined the localization of each modality, surgical resection area and seizure freedom after surgery. RESULTS: Twenty-one (45.7%) out of 46 cases were seizure-free at more than 6 months follow-up. Median duration of postoperative follow-up was 16.5 months. The patients in whom ictal, interictal single equivalent current dipole (SECD) and MRI lesion localization were completely included in the resection had a higher chance of being seizure-free significantly (p < 0.05). Concordance between ictal and interictal SECD localizations was significantly associated with seizure-freedom. Concordance between MRI lesion and ictal SECD, concordance between ictal ICEEG and ictal and interictal SECD, as well as concordance between ictal ICEEG and MRI lesion were significantly associated with seizure freedom. CONCLUSIONS: Ictal MEG can contribute useful information for delineating the resection area in epilepsy surgery. SIGNIFICANCE: Resection should include ictal, interictal SECDs and MRI lesion localization, when feasible. Concordant ictal and interictal SECDs on MEG can be a favorable predictor of seizure freedom.

Perceptions of Saudi Arabian school teachers in private general education schools toward the inclusion of students with disabilities.

BACKGROUND: Teachers' attitudes and perceptions are of significance to the inclusion of students with disabilities in the general education classroom with their typical peers. AIMS: This study quantitatively investigated the perceptions of private elementary school teachers regarding the inclusion of students with disabilities in the general education classroom. METHODS AND PROCEDURE: The study sample comprised 213 teachers working in private elementary schools in Riyadh, Saudi Arabia that offer inclusive special education programming alongside a general education curriculum. The Opinions Relative to the Integration of Students with Disabilities (ORI) survey, was utilized to adapt the survey instrument for this study. RESULTS AND OUTCOMES: We concluded that private school teachers have a slightly negative attitude toward the inclusion of students with disabilities. Although the results did not reveal a relationship between teachers' attitudes and their age or education level, a relationship was found between their perceptions toward inclusion of students with disabilities and the type of disability, the individual teacher's gender, the role of the teacher (general vs. special education), and the individual's training in inclusive education. CONCLUSIONS AND IMPLICATIONS: The implications of the results to Saudi and beyond and suggestions for further research including outside of the urban context are discussed.

Seizure-related injuries in people with epilepsy: A cohort study from Saudi Arabia.

OBJECTIVES: Patients with epilepsy have a high risk of accidents and injuries, resulting in minimized physical activity and social withdrawal. Therefore, we surveyed the prevalence and the types of injuries that patients with epilepsy may endure, and the factors that may increase the risk of injuries. METHODS: In this cohort study, adult and pediatric patients diagnosed with epilepsy (age ≥ 7 years) and a close family member (parents/guardian) attending the outpatient epilepsy clinics at King Fahd Medical City (Riyadh, Saudi Arabia) were interviewed by neurologists. They reviewed the patients' medical records and administered a structured questionnaire to identify and compare several variables, including injury frequency versus seizure type and seizure frequency, number of antiseizure medications used, medication compliance, and work and social limitations. RESULTS: Out of 200 patients, 86 (43%) sustained injuries during an attack of their habitual seizures. Almost half of this group showed a tendency for recurrent injuries. The most common traumas were soft tissue injury (36.5%), head injury (32%), dental injury (8.5%), burns (7%), dislocation (7%), fractures (6.5%), and submersion (2%). Two-thirds of the patients had their injury at home. 64% of patients who had seizures for more than 10 years sustained multiple injuries (P = .003). Injury frequency was higher among patients with daily or monthly seizures (P = .03). 76% of patients who suffered injuries more than twice had generalised tonic-clonic seizures, and genetic generalised epilepsy was encountered more in injured patients (P = .02). Also, patients on polytherapy were more likely than those on monotherapy to have an injury (P = .003). SIGNIFICANCE: Two-fifths of the patients reported seizure-related injuries. The most common were soft-tissue injuries and head traumas, while homes were the most frequent site. In addition, longer epilepsy duration, generalized tonic-clonic seizures, and polytherapy were associated with a higher prevalence of injuries. Therefore, injury prevention strategies should be developed for PWE, especially for those at higher risk.

Factors Affecting Middle School Teachers' Attitudes Toward the Inclusion of Students With Disabilities.

Teachers' positive attitudes are an essential element for the successful inclusion of students who have disabilities in schools with their peers who do not have disabilities. The current quantitative study examines middle school teachers' attitudes toward the inclusion of students with disabilities in regular schools in Saudi Arabia and the factors that affect their attitudes. Middle school teachers (N = 613) from schools in Riyadh responded to a questionnaire regarding their opinions relative to the integration of students with disabilities. The results indicate that middle school teachers have a neutral attitude toward the inclusion of students with disabilities in regular schools. Moreover, teacher-related factors such as gender, position, and experience do not affect teacher attitudes toward inclusion. In contrast, training in inclusion plays a significant role in middle school teachers' attitudes toward inclusion of students with disabilities. The implications of the results and suggestions for further research are discussed in the study.

Public awareness of first-aid management of seizures in Saudi Arabia.

BACKGROUND: First aid measures in cases of epileptic seizures are crucial. Misconceptions about seizure first-aid measures are probably common. Most of the previous data focused on teachers and healthcare providers. The objective of this study was to assess the awareness of seizure first-aid measures and their associated factors in a community sample in Saudi Arabia. METHODS: A cross-sectional study was carried out using an online questionnaire between July 2020 and February 2021. Those who had never heard of epilepsy and healthcare workers were excluded. Overall and individual scores were calculated for first-aid measures during and after the seizures as well as calling the ambulance. RESULTS: A total of 1542 participants were included in the study. The overall awareness score of seizure first-aid measures was 57.3%. The awareness of the need to call the ambulance in special circumstances was the highest individual score (78.3%), followed by measures after the seizure (54.2%), and finally measures during the seizure (48.4%). For the latter, the awareness of injury prevention measures was the highest (74.9%), while the awareness of treatment options was the lowest (12.2%). Overall awareness score was significantly higher in older age (p = 0.015), female gender (p < 0.001), divorced status (p = 0.014), knowing someone with epilepsy (p < 0.001), attending a course or workshop about seizure first-aid (p < 0.001), watching a video on seizure first-aid on any platform (p < 0.001), and having basic life support training (p < 0.001). CONCLUSIONS: The awareness of seizure first-aid measures is still inadequate among the public in Saudi Arabia. The current finding underscores the importance of simulation videos on social media and/or field-training campaigns to improve the public awareness of seizure first-aid measures.

Prevalence of Medically Resistant Epilepsy in Saudi Arabia.

OBJECTIVES: The objective of this study was to evaluate the prevalence of medically resistant epilepsy (MRE) in our hospital and to compare the prevalence with that in other populations. METHODS: We retrospectively analyzed the data of patients who visited the epilepsy clinics at King Fahd University Hospital, Al-Khobar, Saudi Arabia between January 2017 and December 2018. This study included patients aged ≥14 years who had at least 2 unprovoked seizures 24 h apart. Patients who had provoked seizure(s), paroxysmal events, or syncope or had incomplete medical records were excluded. The definition and classification of the International League Against Epilepsy were used. Moreover, we searched the En-glish literature using PubMed and Google Scholar to compare the prevalence of MRE between our population and other populations. RESULTS: In total, 1,151 patients were screened, and 751 patients were included in the final analysis. Of the 751 patients, 229 (male: 56.3%, female: 43.7%; mean age: 32.07 years, and standard deviation, 12.2 years) had MRE, with a cumulative prevalence of 30%. The etiology was as follows: unknown, 63.3% (n = 145); structural, 31.9% (n = 73); genetic, 3.1% (n = 7); and infectious, 1.7% (n = 4). None of the patients had metabolic or immune-related etiologies. CONCLUSION: The prevalence of MRE in our population (30%) is close to that in other populations (30-36.5%). Early identification of such patients is crucial to improve their management.

Non-lesional eating epilepsy with temporo-insular onset: A stereo-EEG study.

Eating Epilepsy (EE) is a rare and often under-recognized form of reflex epilepsy, which manifests with seizures triggered during meals, with or without spontaneous seizures. The electro-clinical manifestations of EE are distinct with variable response to antiseizure drugs. We report the case of a 34-year-old man who was seen for a 4-year history of drug-resistant focal impaired awareness seizures associated with eating without a structural cause. Scalp video-EEG delineated a right temporal seizure focus with atypical features. Subsequent stereo-EEG revealed synchronized seizure onset from the right mesial temporal region and the right inferior insula. Resective surgery of the involved areas rendered this patient seizure-free with 3 years' follow-up. In non-lesional cases of drug-resistant EE, the epileptogenic zone can be large and deep, and therefore stereo-EEG was helpful in determining the seizure onset zone.

The first survey of the Saudi Acute Myocardial Infarction Registry Program: Main results and long-term outcomes (STARS-1 Program).

BACKGROUND: Prior acute coronary syndrome (ACS) registries in Saudi Arabia might not have accurately described the true demographics and cardiac care of patients with ACS. We aimed to evaluate the clinical characteristics, management, and outcomes of a representative sample of patients with acute myocardial infarction (AMI) in Saudi Arabia. METHODS: We conducted a 1-month snap-shot, prospective, multi-center registry study in 50 hospitals from various health care sectors in Saudi Arabia. We followed patients for 1 month and 1 year after hospital discharge. Patients with AMI included those with or without ST-segment elevation (STEMI or NSTEMI, respectively). This program survey will be repeated every 5 years. RESULTS: Between May 2015 and January 2017, we enrolled 2233 patients with ACS (mean age was 56 [standard deviation = 13] years; 55.6% were Saudi citizens, 85.7% were men, and 65.9% had STEMI). Coronary artery disease risk factors were high; 52.7% had diabetes mellitus and 51.2% had hypertension. Emergency Medical Services (EMS) was utilized in only 5.2% of cases. Revascularization for patients with STEMI included thrombolytic therapy (29%), primary percutaneous coronary intervention (PCI); (42.5%), neither (29%), or a pharmaco-invasive approach (3%). Non-Saudis with STEMI were less likely to undergo primary PCI compared to Saudis (35.8% vs. 48.7%; respectively, p <0.001), and women were less likely than men to achieve a door-to-balloon time of <90 min (42% vs. 65%; respectively, p = 0.003). Around half of the patients with NSTEMI did not undergo a coronary angiogram. All-cause mortality rates were 4%, 5.8%, and 8.1%, in-hospital, at 1 month, and at 1 year, respectively. These rates were significantly higher in women than in men. CONCLUSIONS: There is an urgent need for primary prevention programs, improving the EMS infrastructure and utilization, and establishing organized ACS network programs. AMI care needs further improvement, particularly for women and non-Saudis.