Medicine and Health Sciences Commons^™

Factors Associated With Tonic-Clonic Seizures In Patients With Drug-Resistant Mesial Temporal Epilepsy., Ali Akbar Asadi-Pooya, Cyrus Rostami, Amin H. Rabiei, Michael R. Sperling

Department of Neurology Faculty Papers

PURPOSE: Among different seizure types, tonic-clonic seizures are more significant because they are more often associated with morbidity. No prior study has been done to investigate risk factors associated with tonic-clonic seizures in patients with mesial temporal epilepsy.

METHODS: In this retrospective study, all drug-resistant mesial temporal epilepsy patients in the database of patients who underwent epilepsy surgery at Jefferson comprehensive epilepsy center were recruited. These patients were prospectively registered in a database from 1986 till 2014. Patients' age, gender, epilepsy risk factors, age at seizure onset, and preoperative seizure type(s) were registered routinely. Potential risk factors associated with experiencing …

Associations Between Performance On The Rey-Osterrieth Complex Figure And Regional Brain Volumes In Children With And Without Velocardiofacial Syndrome, Kevin Antshel, Jena Peebles, Nuria Abdulsabur, Anne Marie Higgins, Nancy Roizen, Robert Shprintzen, Wanda Fremont, Robert Natasi, Wendy Kates

Robert J. Shprintzen

Ninety-two children with velocardiofacial syndrome (VCFS), a genetic disorder caused by a microdeletion of chromosome 22q11.2 and an age, race, and gender-ratio comparable sample of 59 control participants were included in the project. Participants received an MRI as well as a comprehensive neuropsychological battery; the primary outcome measure in the current report is the Rey-Osterrieth Complex Figure (ROCF). Children with VCFS performed less well on the ROCF and have lower whole brain volume compared to controls. After controlling for whole brain volume differences, children with VCFS have bilaterally less parietal lobe gray and white matter yet more frontal lobe white …

Kyphotic Progression After Thoracolumbar Burst Fractures Treated Conservatively, With Mis, Or Via Open Approach, Mark Rivkin, Howard Eisenbrock

Mark Rivkin

Management of thoracolumbar burst fractures (AO A3) without neurological deficit is subject to debate in the literature. While TLICS provides guidance for injuries necessitating intervention, it makes little mention of best surgical approaches. Furthermore, intact patients with suspected posterior ligamentous complex injury (TLICS 4) compose an additional level of management uncertainty. Present study examined outcomes for TL burst fractures in neurologically intact patients with suspected disruption of the PLC treated with bracing, MIS, or open fixation and fusion.

Nursing Bedside Swallow Screen: How It Affects Outcome Of Stroke Patients, Honoree Ceballos

All Publications

The assessment of a stroke patient’s ability to swallow plays an important role in the management, recovery and patient outcome in stroke. Nurses in the Neuroscience unit encounter this situation daily in caring for stroke patients. This nursing assessment is integral in providing adequate nursing care to prevent complications such as aspiration pneumonia.

Chronic Systemic Immune Dysfunction In African-Americans With Small Vessel-Type Ischemic Stroke, Candice M. Brown, Cheryl D. Bushnell, Gregory P. Samsa, Larry B. Goldstein, Carol A. Colton

Neurology Faculty Publications

The incidence of small vessel-type (lacunar) ischemic strokes is greater in African-Americans compared to whites. The chronic inflammatory changes that result from lacunar stroke are poorly understood. To elucidate these changes, we measured serum inflammatory and thrombotic biomarkers in African-Americans at least 6 weeks post-stroke compared to control individuals. Cases were African-Americans with lacunar stroke (n = 30), and controls were age-matched African-Americans with no history of stroke or other major neurologic disease (n = 37). Blood was obtained > 6 weeks post-stroke and was analyzed for inflammatory biomarkers. Freshly isolated peripheral blood mononuclear cells were stimulated with lipopolysaccharide …

A Clinical Trial To Validate Event-Related Potential Markers Of Alzheimer's Disease In Outpatient Settings, Marco Cecchi, Dennis K. Moore, Carl H. Sadowsky, Paul R. Solomon, P. Murali Doraiswamy, Charles D. Smith, Gregory A. Jicha, Andrew E. Budson, Steven E. Arnold, Kalford C. Fadem

Neurology Faculty Publications

INTRODUCTION: We investigated whether event-related potentials (ERP) collected in outpatient settings and analyzed with standardized methods can provide a sensitive and reliable measure of the cognitive deficits associated with early Alzheimer's disease (AD).

METHODS: A total of 103 subjects with probable mild AD and 101 healthy controls were recruited at seven clinical study sites. Subjects were tested using an auditory oddball ERP paradigm.

RESULTS: Subjects with mild AD showed lower amplitude and increased latency for ERP features associated with attention, working memory, and executive function. These subjects also had decreased accuracy and longer reaction time in the target detection task …

The Neurochemistry Of Group Singing: Bonding And Oxytocin, Jason Keeler

Masters Theses

The purpose of this study was to examine the neurochemical correlates of group vocal improvisation and to determine the feasibility of the research methods. One group of four participants sang together in two conditions: pre-composed and improvised. Concentrations of plasma oxytocin and adrenocorticotropic hormone (ACTH) were measured before and after each singing condition to assess levels of hormones associated with social affiliation, engagement and arousal. Successful implementation of the methodology, including recruitment, data collection, and sample analysis, served as the primary outcome of this study. ACTH concentrations decreased in both conditions, and significantly so in the pre-composed singing condition. Mean …

Levels Of Glycosaminoglycans In The Cerebrospinal Fluid Of Healthy Young Adults, Surrogate-Normal Children, And Hunter Syndrome Patients With And Without Cognitive Impairment., Christian J Hendriksz, Joseph Muenzer, Adeline Vanderver, Jonathan M Davis, Barbara K Burton, Nancy J Mendelsohn, Nan Wang, Luying Pan, Arian Pano, Ann J Barbier

Neurology Faculty Publications

In mucopolysaccharidoses (MPS), glycosaminoglycans (GAG) accumulate in tissues. In MPS II, approximately two-thirds of patients are cognitively impaired. We investigated levels of GAG in cerebrospinal fluid (CSF) in different populations from four clinical studies (including NCT00920647 and NCT01449240). Data indicate that MPS II patients with cognitive impairment have elevated levels of CSF GAG, whereas those with the attenuated phenotype typically have levels falling between those of the cognitively affected patients and healthy controls.

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 …

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 …

Movement Disorders Care In Pakistan, Nadir A. Syed

Pakistan Journal of Neurological Sciences (PJNS)

Earlier discussions about a professional society relating to movement disorders took place about a decade ago and were felt to be a little premature. However PSN nominated Dr Nadir Ali Syed to promote movement disorders related activities. Dr Nadir worked with patients to form a patient centered body, the Pakistan Parkinson's Society which has been quite active in the last several years.

Frequency Of Non-Compliance Of Antiepileptic Drugs Among Patients With Epilepsy, Safia Bano, Ahsan Numan

Pakistan Journal of Neurological Sciences (PJNS)

Non-compliance with anti-epileptic drug treatment results in recurrent seizures and visits to the emergency departments of the hospitals has been identified as a social and economic problem. The aim of this study was to determine the prevalence of epileptic patients with non-compliance of anti-epileptic drugs and the understanding of patients living with epilepsy who presented to the emergency department with seizures. A descriptive study design was employed and the data-collection tools were a questionnaire for this study. The average age of the study population was 46 years. There was 60% males and 40% females in this study. Non-compliance of anti-epileptic …

Comparison Of Oxybutynin And Tolterodine In Treatment Of Detrusor Overactivity Associated With Upper Motor Neuron Lesions, Based On Changes In Urodynamic Parameters, Sumeera Matee, Mahmood Ahmad, Muhammad Farooq Farooq, Saeed Bin Ayaz, Noreen Akhtar

Pakistan Journal of Neurological Sciences (PJNS)

To compare efficacy of oxybutynin and tolterodine in managing Detrusor Overactivity (DO) in Pakistani patients with different upper motor neuron lesions. Methods: A randomized controlled trial was carried out at Armed Forces Institute of Rehabilitation Medicine, Rawalpindi from January to August 2015 including individuals with a diagnosis of DO as a result of upper motor neuron lesions. Maximal detrusor pressure (MDP) and maximal cystometric capacity (MCC) were measured at baseline and at four months post-treatment. Group-A was treated with tolterodine and group-B with oxybutynin. Results: A total of 60 individuals (mean age: 43.9 ± 15 years) were included. Majority (83.3%) …

Efficacy Of Memantine As A Preventive And Therapeutic Intervention For Migraine And Tension Type Headache, Sidra Sattar, Bashir Soomro

Pakistan Journal of Neurological Sciences (PJNS)

To assess the efficacy of memantine as a preventive and therapeutic intervention for migraine and tension type headache. Material and Methods: This quasi experimental (pre and post experimental) was conducted for a period of 6 months. Patients were selected from a private tertiary care hospital setup a total of 44 patients receiving memantine, were selected through purposive sampling technique. Data was analysed using SPSS version 16.0 and associations were made using Chi square test with P value of less than 0.005 was taken as significant. Results: Out of 44 patients 35 (79.9%) were female and 9 (20.5%) were male which …

Epilepsy In The Rural Areas Of Sindh: Knowledge, Beliefs And Practices, Shaheen Ahmed Mughal, Muslim Ali Lakhair, Muhammad Saleem Fiaz, Abdul Qayoom Memon

Pakistan Journal of Neurological Sciences (PJNS)

Unfounded beliefs regarding epilepsy are still common and widespread. Visits to shrines and seeking help from faith healers goes along with thesebeliefs.This creates a major barrier in the timely diagnosis and treatment of epilepsy. Objective: To determine the knowledge, beliefs and practices relating to epilepsy in the rural areas of Sind and how do they differ between educated and uneducated families of patients with epilepsy. Methods: This was an observational study conducted at the Neurology Out-Patient Department of the Peoples Medical University Hospital Nawabshah during the period 1.1.2015 to 30.6.2015. A pro forma was designed incorporating questions pertaining to knowledge,beliefs …

Etiology Of Stroke In Young Pakistani Adults; Results Of A Single Center Study, Ali Zohair Nomani, Mansoor Iqbal, Uzma Jamil, Sumaira Nabi, Shahzad Mughal, Mazhar Badshah, Haris Majeed, Rao Sohail Yasin Khan

Pakistan Journal of Neurological Sciences (PJNS)

The aim of this study was to determine the demographic profile and incidence of young stroke at a tertiary care setup in Islamabad, Pakistan. Materials and Methods: This single centre, cross sectional study was conducted by recruiting 119 patients of either gender, ≥ 12and ≤ 45 years of age with stroke and receiving care at Pakistan Institute of Medical Sciences, Islamabad. Results: Total number of young strokes was 119 out of a total of 322 strokes i-e-, 36.9 %; 1/3rd strokes were in ≤ 45 years of age. Ischemic arterial strokes were 47% (56 out of 119) while venous ischemic …

Spectrum Of Neurological Disorders Presenting At A Neurology Clinic In Tertiary Care Hospital In Peshawar, Pakistan, Sardar M. Alam, Haroon Khan, Khatira Wahid

Pakistan Journal of Neurological Sciences (PJNS)

To ascertain the spectrum of different neurological disorders presenting at a tertiary care neurology clinic in Peshawar, Pakistan. Method: A prospective observational study was conducted of all presentations to the neurology clinic in Northwest General Hospital and Research Center, over a period of one year extending from 1st February, 2013 to 31st January, 2014. Study population included 9386 patients from the neurology clinic over the period of one year. The age distribution of all patients was variable; the youngest patient seen was 1 year old while the oldest was 92 years of age. Appropriate history and neurological examination was conducted …

Validity Of Brighton Criteria In The Diagnosis Of Guillain–Barré Syndrome (Gbs) In Pakistan, Safia Bano, Ahsan Numan, Abubakar Siddique

Pakistan Journal of Neurological Sciences (PJNS)

Guillain–Barré syndrome (GBS) case definitions have been developed in recent past for its quick diagnosis. However, they have not been adopted worldwide especially in developing countries like Pakistan. In this study, we validated the sensitivity of Brighton working group case definitions for GBS at Services Hospital Lahore. Methods: A total of 30 cases of GBS with available clinical history, neurological examination,cerebrospinal fluid(CSF) and nerve conduction studies (NCS) results, and exclusion of related diagnoses were selected (2014–2015). Sensitivity of the Brighton criteria for GBS for level 3 of diagnostic certainty which requires no clinical laboratory testing, level 2 which employs CSF …

Albuminocytological Dissociation In Different Electrophysiological Gbs Variants, Ali Zohair Nomani, Mansoor Iqbal, Haris Majeed, Mazhar Badshah, Sumaira Nabi, Zakir Jan, Uzma Jamil

Pakistan Journal of Neurological Sciences (PJNS)

The objective of our study was to determine the distribution of different electrophysiological variants of GBS and its relationship with albuminocytological dissociation (ACD). The rationale of the study was to determine whether presence or absence of albuminocytological dissociation has any association with NCS findings and whether can be relied upon as an indirect predictor of axonal variant which warrants poor patient out comes versus demyelinating. Materials and Methods: A consecutive series of 76 patients who presented at PIMS over a 12 month period with GBS were included. Nerve Conduction studies (NCS) and Electromyographic (EMG) findings with CSF characterization for albuminocytological …

Plagiarism Penalties, Mohammad Wasay, Anwar Siddiqui

Pakistan Journal of Neurological Sciences (PJNS)

Research in all areas of sciences and humanities has led to the creation of a highly competitive environment which necessitates reporting of ideas, and discoveries at rapid pace. The emergence of new technologies of communication has significantly enhanced the capabilities of individuals to record and transcribe data at high speed. Even though, one can accumulate information in a fraction of time, but quite often the creative skills and ability to write one‘s own original thoughts do not match the required level of output. Writing ideas in one’s own words is not always easy and at times it becomes quite challenging …

Three-Dimensional Neurorehabilitation: A Different Perspective, Ahmad Zaheer Qureshi, Randolph Mitchell Jenkins

Pakistan Journal of Neurological Sciences (PJNS)

The authors have narrated their perspective on rehabilitation of neurological disabilities based upon their experiences in three different regions of the globe, hence the word "three dimensional". It also reflects the need of holistic approach in neurorehabilitation. The article emphasizes the significance of impact of socio-cultural factors on disability and the way different challenges can change outcomes of the same neurological impairment in different health care systems. The understanding, perception and management of disability secondary to any neurological impairment varies greatly from one region to another across the world. Hence treatment guidelines applicable in one socioeconomic setup may not be …

National Institutes Of Health Stroke Scale (Nihss) And Tissue Plasminogen (Tpa) Education For All Critical Care Nurses, Cheriese Rawlins

All Publications

No abstract provided.