Medicine and Health Sciences Commons^™

Community Emergency Medicine: Benefits And Challenges Of Screening For Elder Abuse In The Emergency Department Of A Developing Country, Muhammad Akbar Baig, Asad Mian, Erfaan Hussain, Shahan Waheed

Department of Emergency Medicine

No abstract provided.

Uncovering The Burden Of Intentional Injuries Among Children And Adolescents In The Emergency Department, Uzma R. Khan, Butool Hisam, Nukhba Zia, Mohammed Umer Mir, Olakunle Alonge, Seemin Jamali, Adnan Hyder, Junaid Abdul Razzak

Department of Emergency Medicine

Introduction: In low- and middle-income countries, injuries are a leading cause of mortality in children. Much work has been done in the context of unintentional injuries but there is limited knowledge about intentional injuries among children. The objective of this paper was to understand the characteristics of children with intentional injuries presenting to emergency departments in Pakistan.
Methods: The data was from the Pakistan National Emergency Departments Surveillance (Pak-NEDS), conducted from November 2010 to March 2011 in seven major emergency departments of Pakistan. Data on 30,937 children under 18 years of age was collected. This paper reports frequency of intentional …

Pattern Of Fall Injuries In Pakistan: The Pakistan National Emergency Department Surveillance (Pak-Neds) Study., Jabeen Fayyaz, Shirin Wadhwaniya, Hira Shahzad, Asher Feroze, Nukhba Zia, Mohammed Umer Mir, Uzma Rahim Khan, Sumera Iram, Sabir Ali, Junaid Abdul Razzak, Adnan A. Hyder

Department of Emergency Medicine

Background: We aimed to analyse the frequency and patterns of fall-related injuries presenting to the emergency departments (EDs) across Pakistan.
Methods: Pakistan National Emergency Departments surveillance system collected data from November 2010 to March 2011 on a 24/7 basis using a standardized tool in seven major EDs (five public and two private hospitals) in six major cities of Pakistan. For all patients presenting with fall-related injuries, we analysed data by intent with focus on unintentional falls. Simple frequencies were run for basic patient demographics, mechanism of falls, outcomes of fall injuries, mode of arrival to ED, investigations, and procedures with …

Intentional And Unintentional Poisoning In Pakistan: A Pilot Study Using The Emergency Departments Surveillance Project., Nadeem Ullah Khan, Ricardo Pérez-Núñez, Nudrat Shamim, Uzma Rahim Khan, Naureen Naseer, Asher Feroze, Junaid Abdul Razzak, Adnan A. Hyder

Department of Emergency Medicine

Background: Acute poisoning is one of the most common reasons for emergency department visits around the world. In Pakistan, the epidemiological data on poisoning is limited due to an under developed poison information surveillance system. We aim to describe the characteristics associated with intentional and unintentional poisoning in Pakistan presenting to emergency departments.
Methods: The data was extracted from the Pakistan National Emergency Department Surveillance (Pak-NEDS) which was an active surveillance conducted between November 2010 and March 2011. All patients, regardless of age, who presented with poisoning to any of Pakistan's seven major tertiary care centers' emergency departments, were included. …

The Pediatric Disease Spectrum In Emergency Departments Across Pakistan: Data From A Pilot Surveillance System, Huba Atiq, Emaduddin Siddiqui, Surraya Bano, Asher Feroze, Sayyeda Ghazala Kazi, Jabeen Fayyaz, Shivam Gupta, Junaid A. Razzak, Adnan A Hyder, Asad Mian

Department of Emergency Medicine

Background: There is an increasing number of urgently ill and injured children being seen in emergency departments (ED) of developing countries. The pediatric disease burden in EDs across Pakistan is generally unknown. Our main objective was to determine the spectrum of disease and injury among children seen in EDs in Pakistan through a nationwide ED-based surveillance system.
Methods: Through the Pakistan National Emergency Department Surveillance (Pak-NEDS), data were collected from November 2010 to March 2011 in seven major tertiary care centers representing all provinces of Pakistan. These included five public and two private hospitals, with a collective annual census of …

Dead On Arrival In A Low-Income Country: Results From A Multicenter Study In Pakistan, Munawar Khursheed, Junaid Ahmad Bhatti, Fatima Parukh, Asher Feroze, Syed Saad Naeem, Haseeb Khawaja, Junaid Razzak

Department of Emergency Medicine

BACKGROUND:

This study assessed the characteristics of dead on arrival (DOA) patients in Pakistan.

METHODS:

Data about the DOA patients were extracted from Pakistan National Emergency Department Surveillance study (Pak-NEDS). This study recruited all ED patients presenting to seven tertiary care hospitals during a four-month period between November 2010 and March 2011. This study included patients who were declared dead-on-arrival by the ED physician.

RESULTS:

A total of 1,557 DOA patients (7 per 1,000 visits) were included in the Pak-NEDS. Men accounted for two-thirds (64%) of DOA patients. Those aged 20-49 years accounted for about 46% of DOA patients. Nine …

Pattern Of Presenting Complaints Recorded As Near-Drowning Events In Emergency Departments: A National Surveillance Study From Pakistan., Siran He, Jeffrey C. Lunnen, Nukhba Zia, Uzma Rahim Khan, Khusro Shamim, Adnan Ali Hyder

Department of Emergency Medicine

Background:

Drowning is a heavy burden on the health systems of many countries, including Pakistan. To date, no effective large-scale surveillance has been in place to estimate rates of drowning and near-drowning in Pakistan. The Pakistan National Emergency Department Surveillance (Pak-NEDS) study aimed to fill this gap.

Method:

Patients who presented with a complaint of “near-drowning” were analyzed to explore patterns of true near-drowning (unintentional) and intentional injuries that led to the “near-drowning” complaint. Bivariate analysis was done to establish patterns among patients treated in emergency departments, including socio-demographic information, injury-related information, accompanying injuries, and emergency department resource utilization.

Result: …

Ambulance Use In Pakistan: An Analysis Of Surveillance Data From Emergency Departments In Pakistan., Nukhba Zia, Hira Shahzad, Syed Muhammad Baqir, Shahab Shaukat, Haris Ahmad, Courtland Robinson, Adnan Ali Hyder, Junaid Razzak

Department of Emergency Medicine

Background:

The utilization of ambulances in low- and middle-income countries is limited. The aim of this study was to ascertain frequency of ambulance use and characteristics of patients brought into emergency departments (EDs) through ambulance and non-ambulance modes of transportation.

Methods:

The Pakistan National Emergency Departments Surveillance (Pak-NEDS) was a pilot active surveillance conducted in seven major tertiary-care EDs in six main cities of Pakistan between November 2010 and March 2011. Univariate and multivariate logistic regression was performed to investigate the factors associated with ambulance use.

Results:

Out of 274,436 patients enrolled in Pak-NEDS, the mode of arrival to the …

How Vital Are The Vital Signs? A Multi-Center Observational Study From Emergency Departments Of Pakistan., Amber Mehmood, Siran He, Waleed Zafar, Mirza Noor Ali Baig, Fareed Ahmed, Junaid Razzak

Department of Emergency Medicine

Background:

Vital signs play a critical role in prioritizing patients in emergency departments (EDs), and are the foundation of most triage methods and disposition decisions. This study was conducted to determine the frequency of vital signs documentation anytime during emergency department treatment and to explore if abnormal vital signs were associated with the likelihood of admission for a set of common presenting complaints.

Methods:

Data were collected over a four-month period from the EDs of seven urban tertiary care hospitals in Pakistan. The variables included age, sex, hospital type (government run vs. private), presenting complaint, ED vital signs, and final …

Emergency Care Of Traumatic Brain Injuries In Pakistan: A Multicenter Study, Junaid Ahmad Bhatti, Kent Stevens, Muhammad Umer Mir, Adnan Ali Hyder, Junaid Razzak

Department of Emergency Medicine

Background:

This study assessed factors associated with emergency care outcomes and out-of-pocket treatment costs in traumatic brain injury (TBI) patients in Pakistan.

Methods:

Data on TBI patients were extracted from a four-month surveillance study conducted in the emergency departments (ED) of seven large teaching hospitals. Emergency care access to physicians and imaging facilities were compared with respect to ED outcomes (discharged, admitted or dead). Out-of-pocket treatment costs (in United States dollars [USD]) were compared among different patient strata.

Results:

ED outcomes were available for 1,787 TBI patients. Of them, most were males (79%), aged <25 years (46%) and arrived by ambulances (32%). Nurses or paramedical staff saw almost all patients (95%). Physicians with practice privileges (medical officers, residents or consultants) saw about half (55%) of them. Computerized tomography (CT) scans were performed in two of five patients (40%). Of all, 26% (n = 460) were admitted and 3% died (n = 52). Emergency care factors significantly associated with being admitted or died were arriving by ambulance (adjusted odds ratio [aOR] = 2.37, 95% confidence interval (CI) [95%CI] = 1.78-3.16); seen by medical officer/residents (aOR = 2.11; 95%CI = 1.49-2.99); and had CT scan (aOR = 2.93; 95%CI = 2.25-3.83). Out-of-pocket treatment costs at the ED were reported in 803 patients. Average costs were USD 8, (standard deviation [SD] = 23). Costs were twice as high in those arriving in ambulances (USD 20, SD = 49) or who underwent CT scans (USD 16, SD = 37).

Conclusion:

TBI patients' access to ambulance …

Characteristics Of Chest Pain And Its Acute Management In A Low-Middle Income Country: Analysis Of Emergency Department Surveillance Data From Pakistan, Nino Paichadze, Badar Afzal Khan, Nukhba Zia, Rakshinda Mujeeb, Muhammad Mujeeb Khan, Junaid Ali Razzak

Department of Emergency Medicine

Background:

Chest pain is one of the most frequent causes of emergency department (ED) visits in high-income countries. Little is known about chest pain patients presenting to EDs of low- and middle-income countries (LMICs). The objective of this study was to describe the characteristics of chest pain patients presenting to emergency departments (EDs) of Pakistan and to determine the utilization of ED resources in the management of chest pain patients and their outcomes.

Methods:

This study used pilot active surveillance data from seven major EDs in Pakistan. Data were collected on all patients presenting to the EDs of the participating …

The Pakistan National Emergency Department Surveillance Study (Pak-Neds): Introducing A Pilot Surveillance, Mohammed Umer Mir, Abdulgafoor Muhammad Bachani, Haseeb Khawaja, Shiraz Qayoom Afridi, Sabir Ali, Muhammad Mujeeb Khan, Seemin Jamali, Fareed Ahmed Sumalani, Adnan Ali Hyder, Junaid Ali Razzak

Department of Emergency Medicine

Background:

Evidence-based decision making is essential for appropriate prioritization and service provision by healthcare systems. Despite higher demands, data needs for this practice are not met in many cases in low- and middle-income countries because of underdeveloped sources, among other reasons. Emergency departments (EDs) provide an important channel for such information because of their strategic position within healthcare systems. This paper describes the design and pilot test of a national ED based surveillance system suitable for the Pakistani context.

Methods:

The Pakistan National Emergency Department Surveillance Study (Pak-NEDS) was pilot tested in the emergency departments of seven major tertiary healthcare …

The Pakistan National Emergency Department Surveillance Study (Pak-Neds): Introducing A Pilot Surveillance, Mohammed Umer Mir, Abdulgafoor M. Bachani, Haseeb Khawaja, Shiraz Qayoom Afridi, Sabir Ali, Muhammad Mujeeb Khan, Seemin Jamali, Fareed Ahmed Sumalani, Adnan A. Hyder, Junaid Abdul Razzak

Department of Emergency Medicine

Background

Evidence-based decision making is essential for appropriate prioritization and service provision by healthcare systems. Despite higher demands, data needs for this practice are not met in many cases in low- and middle-income countries because of underdeveloped sources, among other reasons. Emergency departments (EDs) provide an important channel for such information because of their strategic position within healthcare systems. This paper describes the design and pilot test of a national ED based surveillance system suitable for the Pakistani context.

Methods

The Pakistan National Emergency Department Surveillance Study (Pak-NEDS) was pilot tested in the emergency departments of seven major tertiary healthcare …

How Vital Are The Vital Signs? A Multi-Center Observational Study From Emergency Departments Of Pakistan., Amber Mehmood, Siran He, Waleed Zafar, Noor Baig, Fareed Ahmed Sumalani, Junaid Abdul Razzak

Department of Emergency Medicine

BACKGROUND:

Vital signs play a critical role in prioritizing patients in emergency departments (EDs), and are the foundation of most triage methods and disposition decisions. This study was conducted to determine the frequency of vital signs documentation anytime during emergency department treatment and to explore if abnormal vital signs were associated with the likelihood of admission for a set of common presenting complaints.

METHODS:

Data were collected over a four-month period from the EDs of seven urban tertiary care hospitals in Pakistan. The variables included age, sex, hospital type (government run vs. private), presenting complaint, ED vital signs, and final …

Burn Injury Characteristics: Findings From Pakistan National Emergency Department Surveillance Study, Emaduddin Siddiqui, Nukhba Zia, Asher Feroze, Safia Awan, Arifa Liaquat Ali, Junaid Razzak, Adnan Hyder, Asad Latif

Department of Emergency Medicine

Background: Burn injury is an important yet under-researched area in Pakistan. The objective of this study was to determine the characteristics and associated outcomes of burn injury patients presenting to major emergency departments in Pakistan.
Methods: Pakistan National Emergency Department Surveillance (Pak-NEDS) was a pilot active surveillance conducted between November 2010 and March 2011. Information related to patient demographics, mode of arrival, cause of burn injury, and outcomes was analyzed for this paper. Data were entered using Epi Info and analyzed using SPSS v.20. Ethical approval was obtained from all participating sites.
Results: There were 403 burn injury patients in …

Effect Of Diabetes Self-Management Education On Glycemic Control, Compared To Usual Care In Type 2 Diabetic Patients At The Family Medicine Clinic, Aga Khan University Hospital Nairobi, Catherine Wanjiku Gathu

Theses & Dissertations

Background: Globally, the magnitude of disease burden associated with diabetes is high. Poor glycemic control contributes greatly to this burden, especially in the occurrence of related complications. The value of Diabetes Self-Management Education (DSME) is evident in literature, and has been recommended as a way of optimizing glycemic and metabolic control and averting early onset of diabetes complications. Usual care involves spontaneous sharing of information during medical consultations without planned structure or defined time frame. In the African setting, the effect of DSME, and how it compares to usual care, is yet to be fully explored.

Objective: To compare the …

Bomb Blast Injuries: An Exploration Of Patient Characteristics And Outcome Using Pakistan National Emergency Departments Surveillance (Pak-Neds) Data., Irum Qamar Khan, Nadeem Ullah Khan, Rubaba Naeem, Salima Kerai, Kate Allen, Nukhba Zia, Sana Shahbaz, Shiraz Qayoom Afridi, Emaduddin Siddiqui, Uzma Rahim Khan, Adnan A. Hyder, Junaid Abdul Razzak

Department of Emergency Medicine

BACKGROUND:

Bomb blast injuries result in premature deaths and burdening of healthcare systems. The objective of this study was to explore the characteristics and outcome of patients presenting to the emergency departments in Pakistan with bomb blast injuries.

METHODS:

Active surveillance was conducted in seven major emergency departments of Pakistan from November 2010-March 2011. All the sites are tertiary care urban centers. All the patients who presented to the hospital's emergency department (ED) following a bomb blast injury as per self-report or the ambulance personnel were included in the study. Frequency of demographics, injury pattern, and outcomes were calculated.

RESULTS: …

Epilepsy In Pakistan: National Guidelines For Clinicians (Part 2), Fowzia Siddiqi, Shaukat Ali, Mughis Sheerani, Tipu Sultan, Shahid Mustafa, Saleem Barech, Haris Majid, Sarwar Siddiqi, Abdul Malik, Mohsin Zaheer, Wasim Akhter, Rasheed Jooma

Pakistan Journal of Neurological Sciences (PJNS)

In 2013 an international taskforce of the ILAE shaped out a communal definition of Epilepsy.(2) This definition is useful for all or most practical purposes, thus more helpful in management. Epilepsy was defined as recurrent unprovoked seizures i.e 2 or more at least 24 hours apart. The revised practical definition implies that Epilepsy can be considered even after a single seizure in individuals who have other factors predictive of a second unprovoked seizure, a risk set at 60%. The factors include the diagnosis of an epilepsy syndrome, structural lesions like stroke, CNS infections, intraparenchymal contusions after trauma, as well as …

Conflict Between Paternalism And Autonomy., Amber Hussain Sayani

School of Nursing & Midwifery

In the past, paternalism played an important role in making decisions at the end of life. However, in the modern era its significance has become unpopular as it require physicians to decide what is good or bad for the patient without considering patients wish and interest. This commentary article is based on a case study of a woman whose life was lost due to complications of pregnancy. The paper critically reviews this case study, and attempts to provide a reasonable and systematic framework to make sound decisions in similar cases.

Effect Of Raised Body Fat On Vitamin D, Leptin And Bone Mass, Syeda Sadia Fatima, Saad Farooq, Maaida Asif Tauni, Omar Irfan, Faiza Alam

Department of Biological & Biomedical Sciences

Objective: To estimate leptin, vitamin D and bone mineral density levels in individuals with high fat mass, and to assess any correlation.Methods: The cross-sectional study was conducted at the Basic Medical Sciences Institute, Jinnah Post Graduate Medical Centre, Karachi, and Aga Khan University, Karachi, from August 2012 to July 2014, and comprised healthy male volunteers between the ages of 18-60 years. Body fat percentage was determined using bioelectrical impedance analysis and the participants were classified as: Group A (15-21.9); Group B (22-27.9); and Group C ( > 28). Bone mineral density was calculated by ultrasound bone densitometer (T-score between +1 and …

Developing Paediatric Emergency Medicine—An Opinion From A Developing Country Tertiary Care Center, Emaduddin Siddiqui, Shahan Waheed, Irum Qamar Khan

Department of Emergency Medicine

No abstract provided.

Misconceptional Views About Epilepsy Exist Across Social Class System Of Society, Shoaib Rao, Bakhtyar Ali Shah, Nimra Altaf, Fazal M. Arain

Pakistan Journal of Neurological Sciences (PJNS)

Epilepsy affects over 1% of population worldwide. Studies have shown that although our understanding about epilepsy has come a long way, misconceptions about its etiology and treatment exist in rural slums. However, no study has been conducted to see whether such misconceptions exist in middle and upper socio-economic class. This study aims to explore the existence of misconceptions and social stigma in the middle and upper socio-economic class. Materials and Methods: We conducted a survey-based study about epilepsy on 227 participants, belonging to middle and upper socio-economic class. Results: The symptoms of generalized tonic-clonic seizures were correctly described by participants. …

Frequency Of Depression In Patients With Stroke, Muhammad Adnan Aslam, Ahsan Numan, Muhammad Arif, Abubaker Siddueiq

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is a common neurological problem and the third leading cause of death in developed countries of the world. Among survivors, over 50% develop significant disabilities including neuro-psychiatric disabilities. Post stroke depression (PSD) is a common but less reported condition among survivors. Objectives: To determine the frequency of depression in patients with stroke. Materials and methods: This was a cross-sectional study conducted at Department of Neurology, Services Hospital, Lahore from January, 2014 to December, 2014 over a period of 1 year. A total of 100 cases having stroke minimum 1 month ago, were recruited in the study. For evidence of …

Vascular Cognitive Impairment In First Ever Ischemic Stroke Survivors, Sarfraz Ahmed Mahesar, Raheel Ahmed Channa, Alam Ibrahim Siddiqui

Pakistan Journal of Neurological Sciences (PJNS)

Stroke and transient ischemic attacks (TIA) are highly prevalent in Pakistan. Post stroke dementia (PSD) is one of the main causes of dependency in survivors and includes any dementia after a stroke, irrespective of its cause, which includes vascular, degenerative, or mixed. Many Independent survivors have residual physical or cognitive deficits, or behavioral changes which can affect family life and have professional consequences. Study design: Cross sectional study at Department of Neurology CMC Hospital Larkana from Aug-2014 to Jan-2015 to find out frequency of dementia in first ever ischemic stroke patients, its severity and outcome. Methods: Study approved from ethical …

Audit Of Endoscopic Third Ventriculostomy In The Treatment Of Obstructive Hydrocephalus, Hayat Mohammad Khan, Naeemul Haq, Muhammad Usman, Ramzan Hussain

Pakistan Journal of Neurological Sciences (PJNS)

To analyze various aspects of endoscopic third ventriculostomy in the treatment of obstructive hydrocephalus. Material and Methods: This descriptive study was conducted in the Department of Neurosurgery Lady Reading Hospital Peshawar from September 2010 to April 2011. All patients who underwent endoscopic third ventriculostomy were included in the study. Data was analyzed on SPSS version sixteen. Results: Total of 59 patients were included in the study. Thirty two patients were male and 27 were female. Most of the patients presented with headache, vomiting and loss of consciousness. The procedure was successful in 69 percent of cases. Common operative complication was …

Therapeutic Efficacy Of L-Ornithine L-Aspartate In Patients With Hepatic Encephalopathy, Fadieleh Aidrus, Salma Razzaque, Afshan Siddiqui, Ajeet Kumar, M. Ishaq Ghaur

Pakistan Journal of Neurological Sciences (PJNS)

To determine the efficacy of ornithine-aspartate in reducing blood ammonia levels and clinical improvement, as a part of treatment in hepatic encephalopathy. Material & method: A randomized placebo controlled trial was conducted in 2013 in Jinnah medical and dental college hospital Korangi Karachi. One hundred patients with hepatic encephalopathy due to underlying chronic liver disease were randomly assigned into two groups with 50 patients each. One group received three days of ornithine-aspartate infusions (trial-treatment group) and the other group received three days of infusion of placebo (placebo group). Serum ammonia was measured in both groups on day 1 and day …

Serum Calcium And Magnesium Abnormalities In Patients With Status Epilepticus: A Single Centre Tertiary Care Experience, Uzma Jamil, Mazhar Badshah, Ali Zohair Nomani, Muhammad Irshad, Jamal Janjua

Pakistan Journal of Neurological Sciences (PJNS)

Electrolyte imbalances frequently cause seizures, and these seizures may be the sole presenting symptom. Seizures are especially common in patients with sodium disorders, hypocalcemia, and hypomagnesemia. Successful management of patient seizures begins with the establishment of an accurate diagnosis of the underlying electrolyte disturbance, because rapid identification and correction of the disturbance is necessary to control seizures and prevent permanent brain damage. Objectives: To delineate the percentage of people with status epilepticus having calcium and magnesium deficiencies at admission. Methods: The study was carried out from April 2013 to October 2013 at Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. …

Is Oral Lornoxicam Effective In The Treatment Of Acute Migraine Attacks? : A Randomized-Controlled Study, Murat Cabalar Cabalar, Selcuk Dincer, Suleyman Ozyalcin

Pakistan Journal of Neurological Sciences (PJNS)

The aim of this study was to assess the efficacy of lornoxicam (LNX) in the treatment of acute migraine attacks. Material and Methods: This prospective, randomized, double-blind, placebo-controlled trial was conducted administering either LNX or placebo to patients who were diagnosed with migraine without aura according to the International Headache Society (the year 2004) criteria between 2010 and 2012 Results: Of 44 patients with 120 migraine attacks, 38 were female and rest were males. Mean age was 37.75 ± 9.28 years. Patients recorded using LNX in 87 migraine attacks and placebo in 33 migraine attacks, respectively. Pain intensity scores of …

Efficacy Of Memantine In Treating Patients With Fibromyalgia, Sameen Khalid, Bashir A. Soomro, Zahida Mahmood

Pakistan Journal of Neurological Sciences (PJNS)

To evaluate the efficacy of Memantine as a therapeutic intervention for fibromyalgia. Methods: This clinical trial was conducted between October 2014 and December 2014. A total of 30 subjects with diagnosed fibromyalgia presenting to a private neurology clinic in Karachi, Pakistan were selected through purposive sampling technique. Adult patients belonging to both genders were included in the study. Patients were treated with incremental doses of Memantine. Data was analyzed using SPSS version 20 and associations were made using Chi square test with p-value of less than 0.05 taken as significant. Results: Out of 30 patients, 2 (6.7%) were males and …

Epilepsy In Pakistan: National Guidelines For Clinicians, Fowzia Siddiqui, Tipu Sultan, Shahid Mustafa, Sarwar Siddiqui, Shaukat Ali, Abdul Malik, Zafar Sajjad, Saleem Barech, Rasheed Jooma

Pakistan Journal of Neurological Sciences (PJNS)

Epilepsy is one of the most common chronic neurological disorders requiring prolonged treatments and drugs. According to The World Health Organization (WHO), epilepsy is one of those serious brain disorders that affect not only the individual but has a deep impact on the family and society in general. Approximately 50 million people are affected with epilepsy around the world36, though proper epidemiological studies do not exist for Pakistan it is estimated that the prevalence of epilepsy is 9.99/1000. Highest prevalence is seen in people younger than 30 years of age, i.e. about 2 million people and 1/10th of the world …