Migraine Prevalence, Characteristics, Triggers, and Coping Strategies Among Medical Students in Saudi Arabia.

Objective: To determine the prevalence, characteristics, and triggers of migraine and coping strategies used among medical students in Saudi Arabia.Methods: This cross-sectional descriptive study was conducted among undergraduate students in the College of Medicine of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Included students were in their second to sixth academic year of the Bachelor of Medicine or Bachelor of Surgery programs during the 2019-2020 academic year. The diagnosis of migraine was made according to the International Classification of Headache Disorders, Third Edition criteria.Results: A total of 396 students participated in the study; 238 (60.1%) were female and 158 (39.9%) were male. Their age ranged between 18 and 26 years old, with a mean age of 21.32 ± 1.659 years. Only 16 of 396 students fulfilled the criteria for migraine, with a prevalence of 4.04%. Migraine prevalence was higher in females (n = 11, 4.6%) compared to males (n = 5, 3.1%), with a female:male ratio of 1.5:1. The most common triggers associated with migraine were study-related stress (88%) and emotional-related stress (81%).Conclusions: This project was undertaken to evaluate prevalence, triggers, and coping strategies of migraine among medical students. The prevalence of migraine headache in this study was lower compared to other national and international universities, with a higher female to male ratio. Stress was a major trigger among our study population. The findings of this study will add to the growing body of literature on migraine.

Impact of Technology Use on Behavior and Sleep Scores in Preschool Children in Saudi Arabia.

Background: Pre-school children use digital devices both at home and in kindergarten for communication. However, such technologies can also be used for creativity learning and entertainment. Technology usage might exert a negative impact on the psychosocial development of pre-school children, thus necessitating parental monitoring. Previous studies have recommended early intervention for pre-school children by decreasing the duration of digital devices, spending more time with the family, and participation in motor activities to avoid the ill effects of technology. Aim: To investigate the impact of digital device use on the behavioral and sleep scores of preschool children as perceived by parents in Saudi Arabia (SA). Method: This cross-sectional study was conducted across two regions in SA. It was ethically approved by the ethical review board of Imam Abdulrahman Bin Faisal University. The participants were randomly selected from well-baby hospital records, surveyed and interviewed to obtain data for the following measures: demographic data, technology usage, sleep disturbance scale, and behavior scale. Children with special needs or comorbidities were excluded from the study. Descriptive and multivariate regression analysis were done. Results: We recruited 288 children. Most did not attend schools (63.2%), 22.6% were in kindergarten, and 14.2% were in nursery schools. Smart phones were the most commonly used device by the children (42.4%). Most used the technology for 2-3 h/days (34%). Cartoons were the most commonly sought content (42%). The behavior scores for children aged 18-36 months showed a mean value of 5.1, 3.7, and 4.6 for surgency, negative affect, and effortful control, respectively. Children aged 3-5 years showed a mean value of 4.3, 4, and 4.7 for surgency, negative affect, and effortful control, respectively. Sleep disturbance scores for all children showed a mean value of 12.4, 3.5, 3.8, 8, 7.3, and 2.7 on disorders of initiating and maintaining sleep, sleep-breathing disorders, disorders of arousal, sleep-wake transition disorders, disorders of excessive somnolence, and sleep hyperhidrosis, respectively. The mean total sleep score was 37. Multivariate regression analysis showed significant positive relationship between surgency and three factors namely family income of 10,000-15,000 SR (t = 1.924, p = 0.045), fathers' bachelor's degrees (t = 2.416, p = 0.16), and owning a video game device (t = 2.826, p = 0.005<0.05). Negative affect was significantly associated with fathers' diploma level of education (t = 2.042, p = 0.042). Negative significant relationship between effortful control and fathers' secondary level of education (t = -2.053, p = 0.041). There was a significant negative relationship between effortful control and owning a TV and video game device (t = -2.35, -2.855, p = 0.043, 0.005<0.05, respectively). A significant positive relationship was found between child's sleeping score (worse sleep) and watching technology between 3 and 5 h (t = 2.01, p = 0.045), and mothers' unemployment status (t = 2.468, p = 0.014). Conclusion: In conclusion, technology use is associated with a negative impact on children sleep and behavior. Owning a digital device, using tablets, screen viewing for more than 3-5 h, and watching movies were significantly associated with negative child's behavior and sleep.

Postprandial fasting related headache during Ramadan in Saudi Arabia: A cross-sectional study.

BACKGROUND: Headache disorders are classified as primary or secondary; however, among the secondary headaches, those attributed to food ingestion are not well understood. Therefore, we conducted this study to describe and characterize a new headache entity that occurred during the holy month of Ramadan. This headache occurred within 4 h of breaking the fast. METHODS: This is a nationwide descriptive community-based cross-sectional study conducted during the last 10 days of Ramadan, based on a random sample of adults living in Saudi Arabia. The demographic data, headache symptomatology, nature and distribution of the pain, possible triggering and relieving factors, and patient management programs were analyzed. RESULTS: Completed questionnaires were obtained from 16,031 participants. Of those, 3147 (19.6%) reported headaches after breaking the fast in Ramadan. In 84.1% of cases, there was no previous diagnosis of headache or migraine. The characteristics of these postprandial fasting-related headaches mostly was episodic in nature (72%). The nature of the headache was variable, mostly heaviness or tightness (53.9%). Triggering factors included ingestion of fried food in (45%) and coffee (26.3%). Lying down and sleeping was found to be an important relieving factor (61%). CONCLUSION: A new headache entity is being described. Appears to be quite common, occurs less than 2 h following the first meal, and is mostly of the heaviness and tension type.

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.

Clinical presentations, radiological characteristics, and biological risk factors of cerebral venous thrombosis at a University Hospital in Saudi Arabia.

OBJECTIVES: To describe the clinical features and possible etiologies of cerebral vein thrombosis (CVT) in a Saudi Arabian cohort. METHODS: A retrospective, observational design was implemented. Data pertaining to 36 patients (19 female and 17 male) with confirmed CVT diagnosis admitted to a hospital in Saudi Arabia between 2008 and 2019 were obtained and analyzed. RESULTS: The age of patients ranged between 19 to 82 years, and the mean/median age was 33/29 years. Most commonly reported symptoms were headache ( 72%), unilateral lower limb weakness (39%), and seizures (17%). Papilledema was found in 8% of patients. Thrombotic disorders were identified in 14% and infections were identified in 8% of the patients. Two patients had ulcerative colitis, 2 were diagnosed with Behcet's disease, and 2 women were using oral contraceptive pills. Single sinus thrombosis was detected in only 22% of patients. One patient with diabetic ketoacidosis died. Thrombotic disorder was the most common risk factor, followed by that iron deficiency anemia. CONCLUSION: The transverse sinus was the most frequently thrombosed sinus. Iron deficiency anemia emerged as a predisposing preventable condition for CVT, while genetic factors were found to be less important in this cohort.

Spontaneous Bilateral Dissection of the Vertebral Artery: A Case Report.

Spontaneous dissection of the vertebral artery refers to cases that do not involve significant blunt or penetrating trauma as a precipitating factor. However, cases of spontaneous dissection of the vertebral artery do have a history of trivial or minor injury involving some degree of cervical distortion such as chiropractic neck manipulation, as the extreme hyperextension and/or rotation of the neck may create areas of stretch and lead to intimal or adventitial tears in the vertebral artery causing dissection. It is a relatively rare, potentially disabling and sometimes an under-diagnosed cause of stroke. It accounts for 2% of all ischemic strokes and 7% of the cases are bilateral. Herein we present a case of bilateral vertebral artery dissection complicated by basilar artery stroke in a young male patient following chiropractic manipulation of the neck. Neuroimaging modalities upon presentation confirmed the diagnosis. Antiplatelets were administered, and a great clinical outcome after three months was achieved. This report demonstrates the potential hazards associated with neck trauma, including chiropractic manipulation, as it is under reported in Saudi Arabia.

Epilepsy trigger factors in Saudi Arabia. A missing part of the puzzle.

OBJECTIVES: To identify epilepsy triggers prevalent in Saudi Arabia with a view to seizure prevention or achieving a reduction in their frequency. METHODS: This is part of a cross-sectional study carried out in 2020 in a Saudi population in the Kingdom of Saudi Arabia (KSA). We used an online questionnaire to evaluate the most common seizure trigger factors. RESULTS: A total of 546 Saudi patients with epilepsy participated in the study, of which 289 (53%) were women. Of them, 263 (48.1%) had no seizure in the previous 3 months. One hundred and thirty-six (25%) had a family member with epilepsy. The most-reported trigger factor was sleep deprivation reported by 285 (52%), followed by stress 225 (41%), missed medication 210 (38.5%), anxiety 209 (38.3%), and fatigue 184 (33.7%). Conclusions: Sleep deprivation is the most reported trigger factor for seizures in the KSA, followed by stress, followed by missed medication.

Efficacy and Safety of Intravenous Cladribine in Patients with Rapidly Evolving or Early Secondary Progressive Multiple Sclerosis.

Background Multiple sclerosis (MS) is an autoimmune and demyelinating inflammatory disease that affects the central nervous system (CNS). The etiology of the disease remains unknown. Multiple theories highlight genetic, environmental, and infectious factors that may a role. MS is considered as the main cause of disability in young people. Cladribine, known chemically as (2-Chloro-2'-deoxyadenosine), is a purine analog chemotherapy used for hairy cell leukemia and other B-cell lymphomas. The goal of this study was to evaluate the safety and efficacy of cladribine in patients with rapidly evolving or early secondary progressive MS. Methods This observational, single-center, retrospective chart review at the MS Clinic in the Ottawa General Hospital, Ottawa, Canada. A total of 24 patients (median Expanded Disability Status Scale (EDSS) of 4.5) received cladribine (0.07 mg/kg/day) for four consecutive days every six months for ≥ 2 cycles with further cycles depending on lymphocyte recovery or disease activity to a maximum of eight cycles from 2005 until 2016 were included. Four patients who were already diagnosed with rapidly evolving or early secondary progressive multiple sclerosis (SPMS) were induced with cladribine. We evaluated relapse, EDSS, and magnetic resonance imaging (MRI) results. Results Out of 24 patients (ages ranging from 30 - 60), 80% were female. Median follow-up time was seven years. The mean relapse rate in the two years before patients were given cladribine was 1.25. Twenty patients had previously received multiple disease-modifying therapies (DMTs) (≥ 2) prior to receiving cladribine. Following cladribine, eight patients suffered 10 relapses (33.3% of the cohort). Annualized relapse rates (ARRs) were reduced from 1.25 to 0.42, which was statistically significant (p-value = 0.002). There was no mean difference in EDSS (p-value = 0.06): 16% deteriorated, 62% did not change, and 12.5% improved. New MRI activity (new T2 or Gad+ lesions) was noted in only seven of 24 patients.  Conclusion Parenteral cladribine reduced the relapse rate from 1.25 to 0.42, which was statistically significant (p-value = 0.002). MRI activity in patients with rapidly evolving or early secondary progressive multiple sclerosis had a reasonable safety profile.

Impact of depression and fatigue on relapsing remitting multiple sclerosis in Kingdom of Saudi Arabia.

OBJECTIVES: To determine relationship between fatigue, depression with the registration in multiple sclerosis (MS) society activity, and stress with the risk developing a new attack in patients with Relapsing remitting MS (RRMS) in the Kingdom of Saudi Arabia (KSA). METHODS: This was a cohort retrospective study conducted in the KSA between July 2018 and July 2019 which included a total of 465 RRMS patients. Data were collected during interviews using the Beck Depression Inventory (BDI) and Modified Fatigue Impacts Scale (MFIS). Demographic and clinical data were also collected. RESULTS: Of 465 participants, 317 expressed psychological stress before the last attack, 67 of whom developed an attack within 4 weeks, and 250 of whom developed an attack after 4 weeks. Significantly lower BDI scores were associated with registration in MS associations (p=0.003, df = 5). Significantly lower MFIS scores were associated with registration in MS associations (p=0.001, df = 5). CONCLUSION: The majority of RRMS patients have a significant fatigue and depression, and there are significant relationships between registration in the MS society and MFIS and BDI scores where patients who officially registered in MS society have lower score in MFIS and BDI. we recommend regular follow-ups with a psychologist and/or registration with MS societies.