Stroke literacy in the population of the Eastern Province of Saudi Arabia; immediate steps are essential to bridge the gap.

BACKGROUND AND PURPOSE: Stroke is a medical emergency that demands early recognition for time sensitive acute management. Knowledge about stroke in public has not been found satisfactory in most of the studies worldwide. Studies describing the awareness of public about recognition of stroke and its treatment from Saudi Arabia (SA) are deficient. This study aimed to assess the knowledge of general population living in the Eastern Province of SA about stroke in relation to recognition of warning signs, risk factors and available acute treatment. METHODS: A prospective, cross sectional study was conducted using a structured questionnaire distributed through an electronic web site over a period of six months. The data was analyzed with SPSS version 22.0. RESULTS: Among a total of 1,213 respondents, 62.4% were women. Three fourth identified the affected organ correctly. Psychological stress was the most commonly identified risk factor (73.5%) followed by hypertension (63.8%). More than half of the respondents (58.5%) were not aware of diabetes mellitus as a risk factor for stroke. Speech difficulty was the most commonly identified stroke warning sign (64.4%) followed by focal weakness (62.4%). More than half (59.9%) did not recognize facial asymmetry as stroke warning sign. Nearly three fourth of the participants were unaware of t-PA (73.7%) and nearest available health care center for acute stroke management (74.9%). CONCLUSION: Our survey found the stroke literacy in the population of the Eastern Province of SA as non- satisfactory and highlights the importance of taking immediate measure such as mass media campaign and hospital based activities to improve it.

Electrophysiologic severity of carpal tunnel syndrome in diabetic patients of the Saudi population.

OBJECTIVE: To study the frequency of multiple vascular risk factors and electrophysiological severity of carpal tunnel syndrome (CTS) in Saudi diabetic patients. METHODS: This retrospective cross-sectional study was conducted in Neurology Department, King Fahd Hospital of University, Al-Khobar, Kingdom of Saudi Arabia from April 2017 to March 2018 and included 200 patients with CTS. Body parameters, such as blood pressure (BP), weight, height, and body mass index (BMI), along with laboratory and median nerve electrophysiological parameters, of diabetic and non-diabetic patients were compared, and a p-value<0.05 was considered significant. RESULTS: Frequency of hypertension (HTN) and obesity was significantly higher in diabetic patients (p<0.05). Mean median nerve sensory amplitude (MNSA) was lower in diabetic patients (p<0.05).Non-recordable nerves, as well as bilateral and extremely severe CTS (p<0.05), were more frequently seen in diabetic patients. Age, BMI, systolic BP, low serum high density lipoprotein (HDL), high triglycerides, high fasting blood sugar, and high glycated hemoglobin (Hba1c) levels, known to affect the electrophysiological severity of CTS, had a statistically significant association with diabetes. CONCLUSION: Diabetes mellitus (DM) and obesity are the most commonly identified risk factors of CTS. Dyslipidemia, HTN and obesity are more frequently seen in diabetic patients with CTS. These concurrent risk factors are confounding the electrophysiological severity of CTS in these patients. Further larger-scale studies with the control of confounding factors are recommended.

Is non-traditional therapy for multiple sclerosis overwhelming in Saudi Arabia.

OBJECTIVE: To describe the prevalence, knowledge and attitudes about complementary and alternative medicine (CAM) use and the proportion that seek advice from their physician about CAM use. METHODS: This cross-sectional observational study was performed in multiple sclerosis (MS) clinic of King Fahd Hospital of Universityin Alkhobar, Kingdom of Saudi Arabia from January-June 2017. A total of 133 patients have completed the survey. RESULTS: The mean age of patients was 32.3+/-7.6 years and 84 (63.2%) were female. Approximately 83.5% of the patients reported the use of CAM. Among all the reported forms of CAM, vitamins were the most prevalent form, followed by cupping, special prayers and meditation. The majority of patients (62%) obtained knowledge of CAM through social media. A significant number of patients (75.6%) did not disclose the use of CAM to their physician. There was a trend for using CAM more in highly educated, older age, and female patients. The most commonly reported rationale to use CAM was overall improvement in health status. CONCLUSION: The use of CAM among Saudi patients with MS is highly prevalent, without disclosure of its use to physicians. These factors should be taken into account in the doctor-patient consultation to avoid adverse events.

Epidemiological study of epilepsy from a tertiary care hospital in kingdom of Saudi Arabia.

OBJECTIVE: To identify the types of seizures and describe the clinical features, EEG and radiological findings among patients with epilepsy. METHODS: In this retrospective epidemiological study, we analyzed the medical records of the patients with the diagnosis of epilepsy during the study period (January 1st 2016- December 2016) RESULTS: The study included 184 patients, 91 (49.5%) were males and 93 (50.5%) females. Age ranged between 12 and 85 years (mean 35.4+/-19.5 SD years). Most of the patients 150 (82%) had Generalized tonic clonic seizures followed by focal onset in 27 (14%) of the patients. Main EEG abnormality was focal to bilateral was recorded in 53 (41%), idiopathic/ cryptogenic epilepsy was diagnosed in 61% of the patients. The most common abnormalities on brain imaging were temporal/hippocampal atrophy/stroke. The most common cause of symptomatic epilepsy was stroke found in 20(11%) followed by post infectious epilepsy and head trauma. CONCLUSION: Seizure types, EEG characteristics and etiologies of symptomatic epilepsy in our cohort of patients are in accordance with the current literature. Slight discrepancy observed in gender distribution and etiologies for symptomatic epilepsy compared with other studies from Saudi Arabia need to be studied further by prospective and population base studies.

Stroke and seizure continue to be the major brunt of in patient neurology care. An observation from teaching hospital.

OBJECTIVE: To assess the burden and describe the pattern of neurological disorders requiring admissions in a teaching hospital of Al Khobar. METHODS: This is a retrospective, cross sectional study, carried out in the Neurology Department of King Fahd Hospital of the University from January 2009 to December 2016. Neurological disorders were grouped as ischemic stroke, intracerebral hemorrhage, transient ischemic attack, cerebral venous sinus thrombosis, seizure disorders, central nervous system infection, multiple sclerosis, neuropathies, myopathies, headache, dementia and miscellaneous group. Data was entered and analyzed by Statistical Package for the Social Science (SPSS) version 22.0 (IBM Corp., Armonk, NY, USA). RESULTS: The records of 1,317 patients admitted under Neurology Service were analyzed. Out of that, 740 (56.2%) were male and 577 (43.8%) were female. Mean age was 46.9+\-24 years (mean+\-standard deviation). Ischemic stroke was the most common diagnosis (32%) followed by seizures (20%). Multiple sclerosis accounted for around 8% and central nervous system infections 5% of neurological admission. CONCLUSION: Ischemic stroke was found to be the most common etiology for hospitalization in our study. The results of our study are similar to previous literature. An urgent need to control major risk factors such as diabetes and hypertension is warranted to minimize the burden of stroke.

Factors Affecting the Activation and Appearances of Epileptiform Abnormalities in Routine Electroencephalography by Different Provocation Methods.

OBJECTIVE: The objective of this study was to observe the effects of various clinical factors on the activation and appearance of epileptiform abnormalities (EAs) in routine electroencephalography (rEEG) by different provocation methods. METHODS: This observational study involved a review of 136 patients presented for EEG recording due to various indications and their EEG showing EAs during various provocation methods. RESULTS: Generalized spike-wave discharges (GSWDs) were the most frequent activated epileptiform pattern observed in, 81 (59.1%) recordings. This pattern was seen mainly in females 49 (P = 0.00), in patients with generalized seizures 48 (P = 0.00), in prolonged EEG records 3 (P = 0.03), and in both genetic 35 (P = 0.00) and lesional epilepsies 21 (P = 0.00). Focal sharp waves with bilateral synchrony (FSWSBS) were the most activated ictal pattern (P = 0.00). Ictal EAs after hyperventilation (HV) (P = 0.03) and intermittent photic stimulation (IPS) (P = 0.01) were mainly observed in patients with uncontrolled seizures (P = 0.00), and immune-mediated epilepsy (P = 0.02). Females sex (odds ratio [OR]: 1.33, confidence interval [CI]: 0.6-2.6; P = 0.25), bilateral tonic-clonic seizures (OR: 1.17, CI: 0.5-2.4; P = 0.31) and lesional epilepsies (OR: 1.45, CI: 0.7-2.9; P = 0.20) had risk of activation of EAs by provocation methods; however this risk was not statistically significant. While sleep deprivation (SD) (OR: 6.33, CI: 2.2-18.2; P = 0.00), nonrapid eye movement sleep (NREM) (OR: 2.41, CI: 1.0-5.4; P = 0.00), and prolong EEG recording (OR: 1.91, CI: 0.9-3.9; P = 0.04) were leading to a statistically significant risk of activation and appearances of EAs due to provocation. CONCLUSION: Different provocation methods can activate and augment the variety of EEG patterns of diverse clinical significance. Detection of activated ictal EAs is dependent on various patient factors, including seizure control, and the provocation method applied. Further larger prospective cohort studies with adequate sample sizes are warranted.

Résumé Objectif:L'objectif de cette étude était d'observer les effets de différents facteurs cliniques sur l'activation et l'apparition d'épileptiformes. anomalies (EA) dans l'électroencéphalographie (EEG) de routine par différentes méthodes de provocation.Méthodes:Cette étude observationnelle impliquait une examen de 136 patients présentés pour un enregistrement EEG en raison de diverses indications et de leurs EEG montrant des EA au cours de diverses méthodes de provocation.Résultats:Les décharges épileptiformes généralisées étaient le schéma épileptiforme activé le plus fréquemment observé dans 81 enregistrements (59,1 %). Cele schéma a été observé principalement chez les femmes 49 (P = 0,00), chez les patients présentant des crises généralisées 48 (P = 0,00), dans les enregistrements EEG prolongés 3 (P = 0,03), et dans les épilepsies génétiques 35 (P = 0,00) et lésionnelles 21 (P = 0,00). Les ondes aiguës focales avec synchronie bilatérale étaient les ondes critiques les plus activées motif (P = 0,00). Les AE ictales après hyperventilation (P = 0,03) et stimulation photique intermittente (P = 0,01) ont été principalement observées chez les patients avec crises incontrôlées (P = 0,00) et épilepsie à médiation immunitaire (P = 0,02). Sexe féminin (oddsratio [OR] : 1,33, intervalle de confiance [IC] :0,6­2,6; P = 0,25), crises tonico-cloniques bilatérales (OR : 1,17, IC : 0,5­2,4; P = 0,31) et épilepsies lésionnelles (OR : 1,45, IC : 0,7­2,9; P = 0,20) avait un risque d'activation des EA par des méthodes de provocation; cependant, ce risque n'était pas statistiquement significatif. Alors que la privation de sommeil (OR : 6,33, IC : 2,2­18,2; P = 0,00), sommeil à mouvements oculaires non rapides (OR : 2,41, IC : 1,0­5,4; P = 0,00) et prolonger l'enregistrement EEG (OR : 1,91, IC : 0,9­3,9; P = 0,04) entraînaient un risque statistiquement significatif d'activation et d'apparition d'AE par provocation.Conclusion:Différent les méthodes de provocation peuvent activer et augmenter la variété des schémas EEG de signification clinique diverse. La détection des EA ictaux activés est dépend de divers facteurs liés au patient, y compris le contrôle des crises et la méthode de provocation appliquée. D'autres études de cohorte prospectives plus importantes avec des tailles d'échantillons adéquates sont justifiées.

The Relative Impact of Clinical and Investigational Factors to Predict the Outcome in Stroke Patients.

OBJECTIVE: As stroke is still considered a significant cause of mortality and morbidity, it is crucial to find the factors affecting the outcome in these patients. We aimed to interpret the various clinical and investigational parameters and establish their association with the outcome in stroke patients. MATERIALS AND METHODS: This is a retrospective, cross-sectional study, conducted in the Department of Neurology between June 2019 to November 2021. The study involved the review and analysis of medical records pertaining to 264 patients, admitted with the diagnosis of stroke. Various clinical, radiological, and electroencephalographic (EEG) patterns in stroke patients were analyzed and their association with outcome was established. The association between the studied variables was performed by the logistic regression (LR) and presented as odds ratio (OR) and 95% confidence interval (CI). RESULTS: The study sample consisted of 264 patients. Males comprised 165 (62.5%) with the mean participant age of 57.17 ± 18.7 3 years (range: 18-94). Patients younger than 50 years had a better likelihood of a good outcome in comparison to patients older than 50. The admission location was the most significant factor in predicting the outcome ( P = 0.00) in favor of inpatient department and outpatient department (OPD), in contrast to patients admitted directly to intensive care unit (ICU). Normal EEG was associated with good outcome ( P = 0.04; OR, 3.3; CI, 1.01-10.88) even after adjustment of the confounders, whereas patients having marked EEG slowing had a poor outcome ( P = 0.05; OR, 2.4; CI, 0.65-8.79). Among the clinical parameters, hemiparesis ( P = 0.03), trauma ( P = 0.01), generalized tonic-clonic seizures (GTC) ( P = 0.00), and National Institutes of Health Stroke Scale of more than 4 were more likely associated with a poor outcome as well as the presence of intracranial hemorrhage (ICH) or infarction in the cortical and cortical/subcortical locations were associated with poor outcomes. After adjustment of confounders, the factors found to have prognostic significance in favor of good outcomes were inpatients or OPD referrals and normal EEG while direct admission to ICU, marked slowing on EEG, and presence of ICH were found to be associated with poor outcome. CONCLUSION: Certain patterns are predictive of good or worse outcomes in stroke patients. Early identification of these factors can lead to early intervention, which in turn might help in a better outcome. The results of the study, therefore, have some prognostic significance.

Résumé Objectif:Étant donné que l'AVC est toujours considéré comme une cause importante de mortalité et de morbidité, il est crucial de trouver les facteurs qui influent sur le résultat dansces patients. Notre objectif était d'interpréter les différents paramètres cliniques et expérimentaux et d'établir leur association avec le résultat de l'AVC patient. Matériaux et méthodes: Il s'agit d'une étude transversale rétrospective, réalisée au Département de neurologie à partir de juin 2019 à novembre 2021 et comprenait l'examen et l'analyse des dossiers médicaux de 264 patients admis avec un diagnostic d'AVC. Divers profils cliniques, radiologiques et électroencéphalographiques (EEG) chez les patients victimes d'un AVC ont été analysés et leur association avec les résultats a été créé. L'association entre les variables étudiées a été réalisée par régression logistique (LR) et présentée sous forme de rapport de cotes (RC) et intervalle de confiance (IC) à 95 %.Résultats:L'échantillon de l'étude comprenait 264 patients. Les hommes représentaient 165 (62,5 %) avec le participant moyen âge de 57,17 ± 18,7 3 ans (intervalle : 18­94). Les patients de moins de 50 ans avaient une meilleure probabilité d'obtenir un bon résultat par rapport aux patients Le lieu d'admission était le facteur le plus important dans la prédiction du résultat (P = 0,00) en faveur du service d'hospitalisation et le service ambulatoire (OPD), contrairement aux patients admis directement à l'unité de soins intensifs (USI). Un EEG normal était associé à un bon résultat (P = 0,04; RC, 3,3; IC, 1,01-10,88) même après ajustement des facteurs de confusion, alors que les patients ayant marqué un ralentissement de l'EEG avaient un faible plus de 50 ans. résultat (P = 0,05; RC, 2,4; IC, 0,65-8,79). Parmi les paramètres cliniques, hémiparésie (P = 0,03), traumatisme (P = 0,01), tonico-clonique généralisé les convulsions (GTC) (P = 0,00) et l'échelle des accidents vasculaires cérébraux des National Institutes of Health de plus de 4 étaient plus susceptibles d'être associés à un mauvais résultat comme ainsi que la présence d'hémorragie intracrânienne (ICH) ou d'infarctus dans les emplacements corticaux et corticaux/sous-corticaux étaient associés à une Résultats. Après ajustement des facteurs de confusion, les facteurs ayant une signification pronostique en faveur de bons résultats étaient les patients hospitalisés ou l'OPD les renvois et l'EEG normal pendant l'admission directe à l'USI, le ralentissement marqué de l'EEG et la présence de PCI se sont avérés être associés à une mauvaise résultat.Conclusion:Certains modèles sont prédictifs de résultats bons ou pires chez les patients victimes d'un AVC. L'identification précoce de ces facteurs peut conduire à une intervention précoce, ce qui pourrait à son tour aider à obtenir de meilleurs résultats. Les résultats de l'étude ont donc une certaine signification pronostique.

Characteristics of Stroke-related Seizures and their Predictive Factors: A Tertiary Care Center Experience.

BACKGROUND AND PURPOSE: Various risk factors have been described in the literature that increase the risk of seizures associated with stroke. This study was aimed to determine the occurrence rate of poststroke seizures (PSSs) and the associated risk factors in Arab population. MATERIALS AND METHODS: Study included all stroke patients aged >18 years with a minimum follow-up of 24 months following stroke to identify seizure occurrence. Patient's hospital records for all admissions and clinic visits were reviewed. Seizures were classified into early PSS if they occur within 1 week of stroke, and late PSS if they occur after 1 week of stroke. RESULTS: Out of 594 patients, 380 were males. Seizure occurrence was higher in anterior circulation infarctions (94.8%, P < 0.05), cortical location (80.5%, P < 0.05), large artery atherosclerosis (63.8%, P < 0.05), lower activated partial thromboplastin time (APTT) (P = 0.0007), patients with ischemic heart disease (IHD) (P = 0.01), and those who underwent craniotomy (P = 0.001). Nonhigh-density lipoprotein cholesterol was inversely related to PSS (P = 0.01). Higher stroke severity (89%) and confusion (67%) at the time of presentation were independently related to PSS. CONCLUSIONS: Eighty-two (13.8%) patients had PSS. Greater stroke severity at presentation with altered sensorium was independent risk factors for the development of PSS. Patients with underlying IHD, lower APTT, and undergoing neurosurgical intervention require vigilant monitoring for PSS.

Résumé Ontexte et objectif:Divers facteurs de risque ont été décrits dans la littérature qui augmentent le risque de convulsions associées à un AVC. Cette étude visait à déterminer le taux d'occurrence des crises post-AVC (PSS) et les facteurs de risque associés dans la population arabe.Matériels et Méthodes:L'étude a inclus tous les patients victimes d'AVC âgés de plus de 18 ans avec un suivi minimum de 24 mois après l'AVC pour identifier la survenue d'une crise. Les dossiers hospitaliers des patients pour toutes les admissions et visites à la clinique ont été examinés. Les saisies ont été classées en premiers PSS s'ils surviennent dans la semaine suivant l'AVC, et PSS tardif s'ils surviennent après 1 semaine de l'AVC.Résultats:Sur 594 patients, 380 étaient des hommes. Crise d'épilepsie la fréquence était plus élevée dans les infarctus de la circulation antérieure (94,8 %, P < 0,05), la localisation corticale (80,5 %, P < 0,05), l'athérosclérose des grandes artères (63,8 %, P < 0,05), un temps de thromboplastine partielle activé (APTT) inférieur (P = 0,0007), les patients atteints de cardiopathie ischémique (IHD) (P = 0,01) et ceux ayant subi une craniotomie (P = 0,001). Le cholestérol des lipoprotéines non de haute densité était inversement lié au PSS (P = 0,01). Course supérieure la gravité (89 %) et la confusion (67 %) au moment de la présentation étaient indépendamment liées au PSS.Conclusions:Quatre-vingt-deux (13,8 %) patients avait PSS. Une plus grande gravité de l'AVC lors de la présentation avec un sensorium altéré était un facteur de risque indépendant pour le développement du PSS. Les patients avec une IHD sous-jacente, un APTT inférieur et une intervention neurochirurgicale nécessitent une surveillance vigilante du PSS.

Utility of Various Activation Procedures in Provoking Ictal and Interictal Patterns, during Routine Electroencephalogram (rEEG) Recording.

BACKGROUND: Activation procedures (APs) are adopted during routine electroencephalography (rEEG) to provoke interictal epileptiform abnormalities (EAs). This study aimed to observe interictal and ictal (EAs) of different EEG patterns, provoked by various APs. METHODOLOGY: This cross-sectional study was performed in the neurology department of King Fahd hospital of university, Saudi Arabia. The EEGs and medical records of patients who presented for EEG recordings were screened initially, then 146 EEGs provoked EAs due to utilization of APs, were included for analysis. RESULTS: Among all EEGs with provoked EAs, Non-rapid eye movement sleep (NREM) provoked EAs in 93 (63.7%) patients with following patterns, focal spike wave discharges (FSWDs) 45 (P= 0.01), focal spike wave discharges with bilateral synchrony (FSWDBS) 27 (P=0.03) and generalized spike wave discharges (GSWDs) 46 (P=0.01). Intermittent photic stimulation (IPS) most significantly provoked FSWDs in 07 patient (P =0.01) and GSWDs in 30 patients (P=<0.001) 7 patients (P = 0.01) and GSWDs in 30 patients (P < 0.001). Hyperventilation (HV) was associated with a higher occurrence of GSWDs in 37 patients (P =0.01). Female sex 7 (P = 0.02), provoked GSWDs 3 (P = 0.03), NREM sleep 8 (P = 0.04), prolonged EEG record 3 (P = 0.02), clinical events during recording 5 (P ≤ 0.01), diagnosis of genetic 05 (P = 0.03), and immune-mediated epilepsies 2 (P = 0.001) were associated with the provocation of ictal EAs; however, in multiple logistic regression analysis, no statistically significant association of these variables (P ≥ 0.05 each) was noted. CONCLUSION: The provocation of EAs in rEEG with different APs varies according to circumstances, including seizure types, epilepsy etiology, and the type of AP applied. These clinical and procedural parameters affect the diagnostic yield of rEEG and need careful consideration during rEEG recordings. APs adopted during rEEG recording can induce FSWDs, FSWDBS, and GSWDs in the form of either interictal or ictal EAs in various etiologies of epilepsy. Ictal EAs may appear in the form of GSWDs, during NREM sleep, in prolonged EEG records; however, their independent association needs to be evaluated in larger sample studies. Further, prospective cohort studies with adequate sample sizes are warranted.

Résumé Contexte:Des procédures d'activation (AP) sont adoptées lors d'une électroencéphalographie de routine (rEEG) pour provoquer des anomalies épileptiformes (EA) intercritiques. Cette étude visait à observer les inter-critiques et critiques (EA) de différents modèles EEG, provoqués par divers PA.Méthodes:Cette étude transversale a été réalisée dans le département de neurologie de l'hôpital universitaire King Fahd de Khobar, en Arabie Saoudite. Les EEG et les dossiers médicaux des patients qui se sont présentés pour des enregistrements EEG ont été initialement examinés, puis 146 EEG avec des EA provoqués lors de l'utilisation des AP ont été inclus pour analyse.Résultats:Parmi tous les EEG avec des AE provoqués, le sommeil à mouvements oculaires non rapides (NREM) a provoqué des EA chez 93 (63,7 %) patients avec les schémas suivants : décharges d'ondes de pointe focales (FSWD) 45 ( P = 0,01), onde de pointe focale avec bilatéral synchronisation (FSWBS) 27 ( P = 0,03) et décharges d'ondes de pointe généralisées (GSWD) 46 ( P = 0,01). La stimulation photique intermittente (IPS) a provoqué de manière plus significative des FSWD chez 07 patients ( P = 0,01) et des GSWD chez 30 patients ( P = < 0,001) 7 patients ( P = 0,01) et des GSWD chez 30 patients ( P < 0,001). L'hyperventilation (HV) était associée à une fréquence plus élevée de GSWD chez 37 patients ( P = 0,01). Sexe féminin 07 ( P = 0,02), GSWD provoqués 03 ( P = 0,03), sommeil NREM 08 ( P = 0,04), enregistrement EEG prolongé 03 ( P = 0,02), événements cliniques lors de l'enregistrement 05 ( P = < 0,01), diagnostic des épilepsies génétiques 05 ( P = 0,03) et des épilepsies à médiation immunitaire 02 ( P = 0,001) étaient associées à la provocation d'EA critiques, cependant, dans l'analyse de régression logistique multiple, aucune association statistiquement significative de ces variables ( P = > 0,05 chacune) était noté.Conclusion:La provocation d'EA dans l'EEGr avec différents AP varie en fonction des circonstances, notamment des types de crises, de l'étiologie de l'épilepsie et du type d'AP appliqué. Ces paramètres cliniques et procéduraux affectent le rendement diagnostique du rEEG et doivent être soigneusement pris en compte lors des enregistrements rEEG. Les AP adoptés lors de l'enregistrement rEEG peuvent induire des FSWD, des FSWBS et des GSWD sous la forme d'EA inter-critiques ou critiques dans diverses étiologies de l'épilepsie. Les EA critiques peuvent apparaître sous forme de GSWD, pendant le sommeil NREM, dans les enregistrements EEG prolongés; cependant, leur association indépendante doit être évaluée dans des études sur un échantillon plus large. De plus, des études de cohortes prospectives avec des échantillons de taille adéquate sont justifiées.

Clinical and Radiological Parameters Affecting the Yield of Routine Electroencephalography in Various Indications.

OBJECTIVES: To highlight the significance of various clinical and radiological parameters in association with specific electroencephalographic (EEG) patterns in order to prioritize EEG referrals. METHOD: This retrospective, cross-sectional study was conducted in the neurology department of King Fahad University Hospital, Alkhobar, and involved a review and analysis of EEG and medical records pertaining to 604 patients referred for routine EEG. The data were analyzed using SPSS version 22. An association between various parameters and EEG yield was established. RESULTS: Factors associated with the yield of abnormal EEG patterns were diverse, like generalized tonic-clonic seizures (GTCs) (P =.05), status epilepticus (SE) (P =.05), altered level of consciousness (ALC) (P =.00), abnormal movement (P =.00), cardiac arrest (P =.00), prior history of epilepsy (P =.04), chronic renal disease (CRD) (P =.03), abnormal neurological exam (P =.00), and cortical lesions on brain imaging (P =.00). Among the abnormal EEG patterns, epileptiform activity (EA) in EEG was associated with focal seizures (P =.03), GTCs (P =.00), falls (P =.05), cardiac arrest (P =.00), a history of epilepsy (P =.00), and hypoxic ischemic injury (P =.03). Encephalopathy in EEG was also associated with focal sz (P =.02), GTCs (P =.00), SE (P =.01), ALC (P =.00), cardiac arrest (P =.00), history of stroke (P =.01), and epilepsy (P =.00). CONCLUSION: Among the studied parameters, patient level of consciousness, neurological exam findings, and neuroimaging findings, with some discrepancies, were found to be the most consistent in predicting the EEG yield. The study demonstrated the value of a proper neurological exam and careful selection of patients to gain the optimum benefit from the routine EEG.

Résumé Objectifs:Mettre en évidence l'importance de divers paramètres cliniques et radiologiques en association avec des profils électroencéphalographiques (EEG) spécifiques afin de prioriser les références EEG.Méthode:Cette étude transversale rétrospective a été menée dans le département de neurologie de l'hôpital universitaire King Fahad, à Alkhobar, et comprenait un examen et une analyse de l'EEG et des dossiers médicaux de 604 patients référés pour un EEG de routine. Les données ont été analysées à l'aide de la version 22 de SPSS Une association entre divers paramètres et le rendement EEG a été établie.Résultats:Les facteurs associés au rendement de profils EEG anormaux étaient divers, comme les crises tonico-cloniques généralisées (GTC) (P = 0,05), l'état de mal épileptique (SE) (P = 0,05), l'altération du niveau de conscience (ALC) (P = 0,00), les mouvements anormaux (P = 0,00), l'arrêt cardiaque (P = 0,00), les antécédents d'épilepsie (P = 0,04), l'insuffisance rénale chronique (MRC) (P = 0,03), l'examen neurologique anormal (P = 0,00), et lésions corticales sur le cerveau imagerie (P = 0,00). Parmi les profils EEG anormaux, l'activité épileptiforme (EA) dans l'EEG était associée à des crises focales (P = 0,03), des GTC (P = 0,00), des chutes (P = 0,05), un arrêt cardiaque (P = 0,00), des antécédents d'épilepsie (P = 0,00) et une lésion ischémique hypoxique (P = 0,03). L'encéphalopathie dans l'EEG était également associée à sz focal (P = 0,02), GTC (P = 0,00), SE (P = 0,01), ALC (P = 0,00), arrêt cardiaque (P = 0,00), antécédents d'accident vasculaire cérébral (P = 0,01) et épilepsie (P = 0,00).Conclusion:Parmi les paramètres étudiés, le niveau de conscience du patient, les résultats de l'examen neurologique et les résultats de la neuroimagerie, avec quelques divergences, se sont avérés les plus cohérents dans la prédiction du rendement EEG. L'étude a démontré la valeur d'un examen neurologique approprié et d'une sélection minutieuse des patients pour tirer le meilleur parti de l'EEG de routine.

Outcomes and predictors of seizure recurrence in post-stroke epilepsy, a retrospective hospital-based study.

BACKGROUND: The occurrence of seizures following a stroke is a well-recognized complication associated with a significant increase in morbidity and mortality. Despite the numerous studies examining outcomes and risk factors related to post-stroke seizures (PSS), there remains a lack of clarity regarding the clinical characteristics, treatment, and PSS recurrence (PSSR) rates in patients experiencing their initial episode of PSS. PURPOSE: This study aimed to determine the risk factors for developing recurrent seizures after first PSS and their effects on functional outcomes and mortality. METHODS: All patients underwent an electroencephalography (EEG) and were monitored for a minimum of 24 months following the first PSS. The primary endpoint was the recurrence of seizures. Predictive factors for PSSR were determined by using the Cox-proportional hazards model, and the cumulative latency of recurrence at 90, 180, 360, and 720 days was estimated using Kaplan-Meier analysis. RESULTS: Seizure recurred in 36.8% (39/106). Significant association of PSSR was noted with female gender, use of older anti-seizure medications (ASMs) (p<0.001), EEG findings as focal slow wave activity (p<0.001), Ictal epileptiform abnormalities (p=0.015), status epilepticus (p=0.015), and with severe disability (p=0.008). However, multivariate cox-proportional hazards model showed significant association of female gender (HR=3.28; 95% CI: 1.42-7.58; p=0.006). Hazard ratio (HR) was increased with older ASMs use, focal aware seizure types, Ictal EAs, and periodic discharges on EEG; though, statistically significant. CONCLUSION: Factors such as the type of ASMs, EEG findings, and seizure type were significantly linked to PSSR. Female gender was the only independent predictor established. Additionally, significant functional decline was reported with recurrence.

Clinical Implications of Various Electroencephalographic Patterns in Post-Stroke Seizures. The Utility of Routine Electroencephalogram.

Objective: Post-stroke seizures (PSS) are one of the major stroke-related complications. Early therapeutic interventions are critical therefore using electroencephalography (EEG) as a predictive tool for future recurrence may be helpful. We aimed to assess frequencies of different EEG patterns in patients with PSS and their association with seizure recurrence and functional outcomes. Methods: All patients admitted with PSS were included and underwent interictal EEG recording during their admission and monitored for seizure recurrence for 24 months. Results: PSS was reported in 106 patients. Generalized slow wave activity (GSWA) was the most frequent EEG pattern observed (n = 62, 58.5%), followed by Focal sharp wave discharges (FSWDs) (n = 57, 55.8%), focal slow wave activity (FSWA) (n = 56, 52.8%), periodic discharges (PDs) (n = 13, 12.3%), and ictal epileptiform abnormalities (n = 6, 5.7%). FSWA and ictal EAs were positively associated with seizure recurrence (p < .001 and p = .015 respectively) and it remained significant even after adjusting for age, sex, stroke severity, stroke subtype, or use of anti-seizure medications (ASMs). Other positive associations were status epilepticus (SE) (p = .015), and use of older ASM (p < .001). FSWA and GSWA in EEG were positively associated with severe functional disability (p = .055, p = .015 respectively). Other associations were; Diabetes Mellitus (p = .034), Chronic Kidney Disease (p = .002), use of older ASMs (p = .037), presence of late PSS (p = .021), and those with Ischemic stroke (p = .010). Conclusions: Recognition and documentation of PSS-related EEG characteristics are important, as certain EEG patterns may help to identify the patients who are at risk of developing recurrence or worse functional outcomes.

Characteristics and outcomes of large artery occlusion-related stroke due to intracranial atherostenosis: An experience from a single center in Saudi Arabia.

BACKGROUND: Literature on the frequency, response to treatment, and outcomes of acute ischemic stroke (AIS) due to intracranial atherostenosis (ICAS)-related intracranial large artery occlusion (ILAO) from Saudi Arabia is scarce. The aim of this study was to identify the percentage, describe the characteristics, and observe the treatment response in patients with AIS attributed to ICAS-related ILAO. MATERIALS AND METHODS: This cross-sectional study included all adult patients from 2017-2021 who fulfilled the inclusion criteria for the diagnosis of ICAS-related AIS. Patients were dichotomized based on ILAO. Mortality and functional outcomes (FOCs) based on 90 days' dependence level were compared between the two groups. The association between ILAO and other variables was assessed using the Chi-squared test, odds ratios (OR), and 95% confidence interval (CI). RESULTS: ILAO was found in 38.7% of patients with ICAS-related AIS. Men comprised three-fourths of the cohort and were more frequent in the ILAO group. Smoking was associated with increased (P = 0.04) likelihood of ILAO. Patients with ILAO had more severe strokes (P ≤ 0.001) than patients without. Middle cerebral artery was the most common occluded vessel (52%). Functional dependence (P = 0.003, OR = 2.87, CI = 1.42-5.77), malignant transformation (P = 0.001, OR = 8.0, CI = 1.82-35.9), and mortality (P ≤ 0.001, OR = 7.67, CI = 2.40-24.5) were significantly higher among ILAO group. Patients with ILAO with unfavorable FOC were older than those who achieved better FOC (P ≤ 0.001). Thrombolysis (P = 0.02, OR = 2.50, CI = 1.15-5.41) and mechanical thrombectomy (MT) improved FOC in patients with ILAO (P = 0.04, OR = 2.33, CI = 1.10-4.92). CONCLUSION: ILAO is common in patients with ICAS-related AIS. Timely hyperacute stroke treatment can help improve the FOC of otherwise disabling stroke due to ILAO. Raising awareness of the community about stroke is needed, so that a higher number of patients can arrive at hospital within the golden hours. Further data from the region are required to recognize the efficacy of MT in ICAS-related ILAO.

Obesity and metabolic syndrome in patients with epilepsy, their relation with epilepsy control.

Obesity and metabolic syndrome (MetS) are commonly observed in patients with epilepsy (PWE). Obesity and MetS are not only affecting the physical fitness and quality of life of these patients, rather antiepileptic drugs (AEDs) compliance and seizure control have also been affected. The objective of this review is to search the published literature regarding the prevalence of obesity and MetS in PWE and their relation to the response to AEDs. A comprehensive search using PubMed, Cochrane Databases, and Google Scholar was performed. A supplementary citation search was also conducted by analyzing the reference lists of identified sources. The initial search revealed 364 articles of potential relevance. The studies were analyzed in detail to obtain clinical information relevant to the objectives of the review. Many observational, case control studies, randomized control trials and few review articles were included for critical appraisal and review writing. Epilepsy is associated with MetS and obesity in all age groups. AEDs and lack of exercise are the chief causes while metabolic disturbances such as adiponectin, mitochondrial dysfunction, valproic acid (VPA)-associated insulin resistance, leptin deficiency, and endocrine dysfunction are also addressable factors. Although the risk of drug-resistant epilepsy (DRE) is also higher among obese PWE, the interaction between, MetS, and its components with DRE remain to be fully investigated. Further research is required to elucidate their interplay. Appropriate and careful selection of AEDs without compromising therapeutic efficacy supplemented by lifestyle counseling for exercise and diet should be practiced to avoid weight gain and potential DRE.

Résumé L'obésité et le syndrome métabolique (MetS) sont couramment observés chez les patients épileptiques (PWE). L'obésité et le MetS n'affectent pas seulement la condition physique et la qualité de vie de ces patients, mais plutôt l'observance des médicaments antiépileptiques (DEA) et le contrôle des crises ont également été affectés. L'objectif de cette revue est de rechercher la littérature publiée concernant la prévalence de l'obésité et du MetS chez les PWE et leur relation avec la réponse aux DEA. Une recherche exhaustive à l'aide des bases de données PubMed, Cochrane et Google Scholar a été effectuée. Une recherche de citation supplémentaire a également été effectuée en analysant les listes de référence des sources identifiées. La recherche initiale a révélé 364 articles potentiellement pertinents. Les études ont été analysées en détail afin d'obtenir des informations cliniques pertinentes aux objectifs de la revue. De nombreuses études observationnelles, des essais contrôlés randomisés et des articles de synthèse ont été inclus pour l'évaluation critique et la rédaction de la synthèse. L'épilepsie est associée au MetS et à l'obésité dans tous les groupes d'âge. Les antiépileptiques et le manque d'exercice sont les principales causes, tandis que les troubles métaboliques tels que l'adiponectine, le dysfonctionnement mitochondrial, la résistance à l'insuline associée à l'acide valproïque (VPA), la carence en leptine et le dysfonctionnement endocrinien sont également des facteurs adressables. Bien que le risque d'épilepsie résistante aux médicaments (ERD) soit également plus élevé chez les PWE obèses, l'interaction entre le MetS et ses composants avec l'ERD reste à étudier en profondeur. Des recherches supplémentaires sont nécessaires pour élucider leur interaction. Une sélection appropriée et minutieuse des antiépileptiques sans compromettre l'efficacité thérapeutique, complétée par des conseils sur le mode de vie pour l'exercice et le régime alimentaire, doit être pratiquée afin d'éviter la prise de poids et un toucher rectal potentiel. Mots clés: syndrome métabolique ; épilepsie; médicaments antiépileptiques; épilepsie résistante aux médicaments.

Colloidal/Calcified Neurocysticercosis at University Hospital of KSA: A Case Series.

Background: Neurocysticercosis (NCC) is considered the most common central nervous system (CNS) helminthic infection. The prevalence of NCC cases in the Middle East has increased in recent years. Thirty-nine cases of NCC were reported between 2003-2011 in the Arabian Peninsula, among, five cases being from the kingdom Saudi Arabia (KSA). Most of the cases reported from the KSA were presented with seizures, and they belonged to expatriate workers or their related contacts. In this case series, we presented three cases of colloidal/calcified NCC. Cases: Our patients were diagnosed with NCC based on epidemiologic exposure, clinical features, and typical radiological findings. Stool samples for ova and parasites were negative in all three cases. Among these cases, two patients were immigrants and belonged to endemic areas, and third case who is the youngest in this series was a Saudi, without any history of exposure to any source. Results: The first and the third cases were treated with Albendazole and Dexamethasone. We did not offer any medication regarding NCC in the second case as he had asymptomatic NCC and the disease was inactive so did not mandate anti-helminth medication. Conclusion: NCC in KSA, like in non-endemic countries, is not a rare or unusual infection anymore, presenting with seizures or incidental findings in an asymptomatic state. Vigilant diagnostic protocols with efficient diagnostic tools are required for detecting carriers of the adult form of the parasite. Timely detection of these carriers can avoid further spread and its related complications in the Saudi population.

Prospective Matched Case-Control Study of Over-Early P100 Wave Latency in Migraine with Aura.

A sizable portion of the world's population suffers from migraines with aura. The purpose of this research is to describe the findings of a case-control study that was carried out to gain a better understanding of how migraine with aura manifests. The research looked at the P100 delay of the visual-evoked potential in both eyes of 92 healthy people and 44 patients who suffered from migraines with visual aura. All of the participants in the study were recruited from King Fahad University Hospital in Saudi Arabia. Both sets of people had the same ancestry and originated from the same location. Patients who suffered from migraines with aura exhibited a significantly shorter P100 delay in both eyes compared to healthy controls (p = 0.001), which is evidence that their early visual processing was distinct. In order to arrive at these findings, we compared people who suffer from migraines with aura to people who do not suffer from migraines and used them as subjects. These findings contribute to the ongoing attempts to bring the disease under control and provide vitally significant new information regarding the functioning of headaches with auras. The primary focus of study in the future should be on determining the nature of the connection between issues with early visual processing and headaches with aura.

Association between glycated hemoglobin and functional outcomes in patients with intracranial large artery atherosclerotic disease-related acute ischemic stroke: identifying the magic number.

Objective: This study aimed to investigate the effect of the glycated hemoglobin A1c (HbA1c) level on the functional outcome (FOC) in patients with intracranial large artery atherosclerotic disease (ICLAD)-related acute ischemic stroke (AIS). Methods: This retrospective study enrolled patients with ICLAD-related AIS who were admitted to King Fahd University Hospital between January 2017 and September 2021. Patients were divided into two groups based on the optimal cutoff HbA1c level determined using receiver operating characteristic curve analysis-those with HbA1c ≤6.9% and those with HbA1c >6.9%. Demographic and other clinical characteristics were compared between the two groups using chi-square tests. The association between HbA1c and 90-day FOC was assessed using the chi-square test and odds ratios (ORs). Multivariate analysis was performed to adjust for confounding factors. Results: A total of 140 patients were included in the analysis. A significant association was observed between the HbA1c level and FOC. Compared to patients with HbA1c ≤6.9%, patients with HbA1c >6.9% were more likely to have an unfavorable FOC [p = <0.001, OR = 2.05, 95% confidence interval (CI) = 1.33-3.14]. The association between HbA1c >6.9% and unfavorable FOC was sustained even after adjusting for confounding factors (p = 0.008) and atherosclerosis risk factors (p = 0.01). HbA1c >6.9% was also associated with higher ORs for in-hospital complications (p = 0.06, OR = 1.34, 95% CI = 1.02-1.77) and mortality (p = 0.07, OR = 1.42, 95% CI = 1.06-1.92) although these associations did not attain significant p-values. Conclusion: HbA1c >6.9% was significantly associated with unfavorable FOC in ICLAD-related AIS. However, further studies with larger sample sizes are required to verify whether HbA1c is an independent predictor of poor FOC. Nevertheless, targeting HbA1c <7% should be the goal of physicians when managing patients at high risk of ICLAD.

Important Factors to Expect the Outcome After Intracerebral Hemorrhage: An Observational Study From a University Hospital in Saudi Arabia.

BACKGROUND: Intracerebral hemorrhage (ICH) has worse clinical outcomes than other stroke types. The risk factors contributing to ICH outcomes are not entirely understood, and published literature from Saudi Arabia on ICH outcomes is limited. Our goal was to study the specific clinical and imaging determinants of ICH outcomes. METHODS: We retrospectively retrieved all patients with spontaneous ICH (SICH) from a prospective King Fahd Hospital University registry between 2017 and 2019. The clinical characteristics of ICH events and data on clinical outcomes (6 to 12 mo) were recorded. Groups of patients with a favorable modified Rankin Scale of 0 to 2 and nonfavorable outcomes of a modified Rankin Scale of 3 to 6 were investigated. The relationship between the clinical characteristics of the SICH event and its outcomes was assessed using linear and logistic regression analyses. RESULTS: A total of 148 patients with a mean age of 60.3 years (±15.2) and a median follow-up of 9 months were included. Unfavorable outcomes were reported in 98 patients (66.2%). The ICH event variables associated with unfavorable outcomes were impaired renal function, Glasgow Coma Score <8, hematoma volume, hematoma expansion, and intraventricular extension (IVE). CONCLUSIONS: Our study demonstrated important clinical and radiologic features in patients with ICH that may affect their clinical long-term functional outcomes. A larger multicenter study is required to validate our results and evaluate the methods to improve health care in patients with SICH.

Prevalence and Clinico-Radiologic Spectrum of Intracranial Atherosclerotic Disease-Related Stroke: An Observation from a Single Center in Saudi Arabia.

BACKGROUND: Intracranial atherosclerotic disease (ICAD) is an important etiologic subtype of acute ischemic stroke (AIS). However, little direct evidence is available regarding ICAD-related stroke in Saudi Arabia (SA). This study aimed to identify the prevalence and describe the clinico-radiological spectrum of ICAD-related AIS in a SA cohort. METHODS: This was a hospital-based retrospective study enrolling patients with ICAD-related AIS between 2017 and 2020. The electronic charts were reviewed. The mechanisms of stroke were identified as artery-to-artery embolization (AAE), in situ thrombotic occlusion, hypoperfusion, or perforator branch occlusion. Pearson's χ 2 test was performed to calculate the P values to establish the statistical significance of factors that could correlate with the mechanisms of stroke and functional outcome. RESULTS: ICAD was found in 133 of AIS comprising 26% of total. Data from all patients were reviewed. Left ICA (25%) was the most frequently affected vessel. Territorial pattern (63.9%) was the most common infarct pattern, and AAE (44.3%) was the most common underlying mechanism. Perforator branch occlusion was more prevalent in women than in men. Malignant and hemorrhagic transformation ( P =0.00) were more prevalent in the AAE group. Left-sided vascular involvement was statistically associated with unfavorable outcomes than the right ( P =0.019). CONCLUSIONS: The prevalence of ICAD in our cohort from Western Asia did not differ from that in Southern Asia. ICA involvement was observed more frequently than previously reported. Further research from SA is required to better understand ICAD-related strokes in this region.

Non-HDL Cholesterol, Obesity, and Metabolic Syndrome in Epileptic Patients.

Objective: To compare cardiovascular risk factors in patients with epilepsy with those of non-epileptic neurologic patients to determine their association with antiepileptic drug therapy.Methods: This observational study with a cross-sectional design was performed in a tertiary care hospital in the Eastern Province of Saudi Arabia from January to December 2018. A total of 110 patients with epilepsy were included in the study, along with 46 age- and sex-matched non-epileptic controls (approximate ratio of 2:1). Blood pressure reading (BP), anthropometric measurements, fasting blood sugar levels, and fasting lipid profiles were performed for all subjects.Results: Raised non-high-density lipid cholesterol (nHDLC) was the most common cardiovascular risk in epileptic patients, with a frequency of 51% compared to 30.4% in controls (P = .019). Epileptic patients who were male (58.3%, 28/48, P = .012) and those aged < 35 years (47.3%, 26/55, P = .036) were more likely to have high nHDLC. Obesity was also common in epileptic patients with frequency of 49.1% (n = 54) versus 30.4% (n = 14) in controls (P = .032). Metabolic syndrome was present in 26.3% of epileptic patients versus 23.9% of controls (P = .749). Among the epileptic patients, of those with high nHDLC, 85.7% had satisfactory seizure control (P = .019).Conclusions: Raised nHDLC and obesity but not metabolic syndrome appear to be highly prevalent in epileptic patients compared to those without epilepsy. Antiepileptic drugs alone may not play a role in developing high lipid levels. More studies are needed to determine the causes of higher risk factor profile in epileptic patients and their relationship with seizure control.