Medicine and Health Sciences Commons^™

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. …

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 …

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 …

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 …

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 …

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%) …

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. …

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 …

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 …

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 …

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 …

Ependymal Tumors With Oligodendroglioma Like Clear Cells: Experience From A Tertiary Care Hospital In Pakistan, Fauzan Alam Hashmi, Muhammad Faheem Khan, Saad Akhtar Khan, Muhammad Waqas, Muhammad Ehsan Bari, Arsalan Ahmed

Section of Neurosurgery

Background: Ependymal tumors with oligodendroglioma like clear cells have never been reported from Pakistan. We aimed to see the features and outcomes of this rare entity.
Methods: It was retrospective cohort conducted at the Department of Neurosurgery, Aga Khan University from 2003 to 2013. The medical records and radiology of patients with proven histopathology were reviewed. Analysis was done on SPSS 20.
Results: Eleven cases of ependymal tumors with clear cells were found, which equated to 1.5% of the total tumor burden in 11 years. The median age was 49 years. Most common presenting symptom was headache 54.5%. Out of …

Surveillance In The Service Of Safety, Rashid Jooma

Section of Neurosurgery

The World Report on Road Traffic Injury Prevention of 2004 recommended that the newly motorizing countries establish road injury surveillance to define the burden, identify highrisk groups, plan intervention and monitor their impact. Despite its stated importance in the literature, very few examples of sustained surveillance systems are reported from low income countries. This presentation shares the results of an urban RTI surveillance program that has been running for the past 8 years since 2007 in the emergency departments of five major hospitals in Karachi, Pakistan. We describe the process of establishing the road injury surveillance system incorporating a multi-institution …

Bicompartmental Decompressive Craniectomy: Report Of Two Cases, Saad Akhtar, Badar Uddin Ujjan, Muhammad Waqas, Muhammad Waqas Khan Waqas Khan, Gohar Javed

Section of Neurosurgery

A recent study of randomized controlled trials showed favorable outcomes with use of decompressive craniectomy in managing and treating uncontrolled intracranial pressures accompanied with cerebral edema due to trauma. We present the details of bicompartmental decompressive craniectomy on two patients who presented with severe head trauma of supra- and infratentorial pathologies. The surgical management techniques and long-term follow-up are discussed in detail.

Neurofibromatosis Type 2 Patient Presenting With Medulloblastoma, Jan Kalimullah, Abdul Malik Amir Humza Sohail, Rai Shahjehan, Sabeehuddin Siddique, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Neurofibromatosis type 2 (NF2) is an autosomal dominant syndrome with a frequency of 1 in 25,000 live births and a penetrance of almost 100% by the sixth decade of life. The main tumors occurring in NF2 patients are bilateral vestibular schwannomas, other peripheral, cranial and spinal nerve schwannomas, intracranial and intraspinal meningiomas, ependymomas, and gliomas.
Case description: We report the case of a 6-year-old boy who presented with a 1-month history of nausea and recurrent vomiting. Physical examination was positive for ataxic gait and left-sided facial nerve palsy. Family history was positive for NF2 in the patient's father and …

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

Section of Neurology

No abstract provided.

A Randomized Controlled Behavioral Intervention Trial To Improve Medication Adherence In Adult Stroke Patients With Prescription Tailored Short Messaging Service (Sms)-Sms4stroke Study., Ayeesha Kamran Kamal, Quratulain Shaikh,, Omrana Pasha, Iqbal Azam Syed, Muhammad Islam,, Adeel Ali Memon, Hasan Rehman, Masood Ahmed Akram,, Muhammad Affan, Sumaira Nazir, Salman Aziz, Muhammad Jan, Anita Andani, Abdul Muqeet, Bilal Ahmed, Shariq Khoja

Department of Medicine

Background: The effectiveness of mobile technology to improve medication adherence via customized Short Messaging Service (SMS) reminders for stroke has not been tested in resource poor areas. We designed a randomized controlled trial to test the effectiveness of SMS on improving medication adherence in stroke survivors in Pakistan.

Methods: This was a parallel group, assessor-blinded, randomized, controlled, superiority trial. Participants were centrally randomized in fixed block sizes. Adult participants on multiple medications with access to a cell phone and stroke at least 4 weeks from onset (Onset as defined by last seen normal) were eligible. The intervention group, in addition …

Deadly Heat Wave In Karachi, July 2015: Negligence Or Mismanagement?, Adnan Salim, A. Ahmed, N. Ashraf, M. Asher

Section of Neurosurgery

No abstract provided.

Hereditary Sensory Autonomic Neuropathy Ii, A Rare Disease In A Large Pakistani Family, Fazal M. Arain, Prem Chand

Department of Paediatrics and Child Health

Hereditary Sensory Autonomic Neuropathy II (HSAN II) is a rare genetic disorder, characterized by severe loss of pain, temperature and touch sensation. Injuries in these patients can progress to necrosis and shedding of digits and limbs. Here we report two cases of HSAN II belonging to a Pakistani family. Individual 1, a forty five year old man, had complete loss of pain sensation since birth. Self-mutilation and complication of injuries resulted in the shedding of all the digits and right foot and surgical amputation of left leg. Individual 2, a five year old girl,had delay in healing of wounds and …

Stroke Manifesto - What Must Be Done For Stroke Care In Pakistan, Abdul Malik, Ismail Khatri, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.