Medical Specialties Commons^™

Ketogenic Diet Decreases Emergency Room Visits And Hospitalizations Related To Epilepsy., Husam R. Kayyali, Anastasia Luniova, Ahmed Abdelmoity

Manuscripts, Articles, Book Chapters and Other Papers

Background. Approximately, one-third of patients with epilepsy are refractory to pharmacological treatment which mandates extensive medical care and imposes significant economic burden on patients and their societies. This study intends to assess the impact of the treatment with ketogenic diet (KD) on reducing seizure-related emergency room visits and hospitalizations in children with refractory epilepsy. Methods. This is a retrospective review of children treated with the KD in one tertiary center. We compared a 12 months' period prior to KD with 12 months after the diet was started in regard to the number of emergency department (ED) visits, hospitalizations, …

Epidural Hematoma Treated Conservatively: When To Expect The Worst, Julie Lamoureux

All Publications

Background: The Brain Trauma Foundation’s 2006 surgical guidelines have objectively defined the epidural hematoma (EDH) patients who can be treated conservatively. Since then, the literature has not provided adequate clues to identify patients who are at higher risk for EDH progression (EDHP) and conversion to surgical therapy. The goal of our study was to identify those patients.

Methods: We carried a retrospective review over a 5-year period of all EDH who were initially triaged for conservative management. Demographic data, injury severity and history, neurological status, use of anticoagulants or anti-platelets, radiological parameters, conversion to surgery and its timing, and Glasgow …

Vitamin D Clinical Relevance In The Recovery From Traumatic Brain Injury Among The Military Population, Yuisa M. Colón

Honors Undergraduate Theses

Background: Traumatic brain injury (TBI) still remains a difficult disorder to treat. TBI has been associated to chronic neuroinflammation and a high risk for neurodegenerative disorders. Since 2001 between ten to twenty percent of all deployed military members have suffered a combat-related TBI. Nearly twenty to thirty percent of those will experience chronic cognitive, behavioral and somatic symptoms after suffering a TBI.
Methods: The objective of this review is to evaluate current literature examining vitamin D as a neurosteroid with protective properties and its clinical relevance after traumatic brain injury. Vitamin D is known to participate in neurobiological …

Oscillation Phase Locking And Late Erp Components Of Intracranial Hippocampal Recordings Correlate To Patient Performance In A Working Memory Task, Jonathan K. Kleen, Markus E. Testorf, David W. Roberts, Rod C. Scott

Dartmouth Scholarship

In working memory tasks, stimulus presentation induces a resetting of intracranial temporal lobe oscillations in multiple frequency bands. To further understand the functional relevance of this phenomenon, we investigated whether working memory performance depends on the phase precision of ongoing oscillations in the hippocampus. We recorded intra-hippocampal local field potentials in individuals performing a working memory task. Two types of trials were administered. For high memory trials presentation of a list of four letters ("List") was followed by a single letter memory probe ("Test"). Low memory load trials, consisting of four identical letters (AAAA) followed by a probe with the …

Health-Related Fitness For Children And Adults With Cerebral Palsy, Yvette Blanchard, Mary E. Gannotti, Wendy Romney

All PTHMS Faculty Publications

Position Statement of ACSM Sports Medicine Basics 2016: Health-related physical fitness for persons with Cerebral Palsy should be developed in the same model as fitness for all of us: start early, be easily available and continue throughout the life span.

Eeg Interictal Spike Detection Using Artificial Neural Networks, Howard J. Carey Iii

Theses and Dissertations

Epilepsy is a neurological disease causing seizures in its victims and affects approximately 50 million people worldwide. Successful treatment is dependent upon correct identification of the origin of the seizures within the brain. To achieve this, electroencephalograms (EEGs) are used to measure a patient’s brainwaves. This EEG data must be manually analyzed to identify interictal spikes that emanate from the afflicted region of the brain. This process can take a neurologist more than a week and a half per patient. This thesis presents a method to extract and process the interictal spikes in a patient, and use them to reduce …

Translating Knowledge For Action Against Stroke--Using 5-Minute Videos For Stroke Survivors And Caregivers To Improve Post-Stroke Outcomes: Study Protocol For A Randomized Controlled Trial (Movies4stroke)., Ayeesha Kamran Kamal, Adeel Khoja, Bushra Usmani, Nargis Asad, Asma Ahmed, Iqbal Azam, Sarah Saleem, Saleem Sayani

Department of Medicine

Background: Two thirds of the global mortality of stroke is borne by low and middle income countries (LMICs). Pakistan is the world’s sixth most populous country with a stroke-vulnerable population and is without a single dedicated chronic care center. In order to provide evidence for a viable solution responsive to this health care gap, and leveraging the existing >70 % mobile phone density, we thought it rational to test the effectiveness of a mobile phone-based video intervention of short 5-minute movies to educate and support stroke survivors and their primary caregivers.

Methods: Movies4Stroke will be a randomized control, outcome assessor …

Where Is Pain In The Brain?, Marshall Devor

Animal Sentience

Key argues that fish cannot experience pain based on (1) brain imaging in humans, (2) consequences of lesions and (3) direct brain stimulation. Imaging indeed shows that pain-relevant signals reach the cortex, but not that they underlie the subjective experience of pain. Lesions and stimulation data are more to the point, but Key paints an idiosyncratic and misleading picture of their effects. S1 and S2 ablation does not eliminate evoked or spontaneous pain, although there may be up- or down-modulation. Likewise, stimulation of pain-associated cortical areas rarely induces pain, and pain almost never occurs at the onset of epileptic seizures. …

Spectrum Of Intracerebral Hemorrhage In Children: A Report From Picu Of A Resource Limited Country, Qalab Abbas, Qurat Ul Ain Merchant, Bushra Nasir, Anwar Ul Haque, Basit Salam, Gohar Javed

Department of Paediatrics and Child Health

Intracerebral hemorrhage (ICH) in children is a rare but disabling disease that accounts for almost half cases of stroke. We report our experience of ICH in children. Retrospective review of medical records of children (1 month-16 years) admitted in Pediatric Intensive Care Unit between January 2007 and December 2014 was done. Data collected included age, gender, presentation, examination findings, neuroimaging done (CT, MRI, and angiography) management (conservative/intervention), and outcome. Results are presented as frequency and percentages. Of the total 50 patients, 58% were male and 26% were <1 year. On presentation 44% had vomiting, 42% had seizures, and GCS < 8 while 40% had altered level of consciousness. Single bleed was present in 88%, 94% had supratentorial bleed, and 32% had intraventricular extension. 72% had bleed volume of <30 mL and 8% had >60 mL. CT scan was done in 98% patients and MRI in 34%, …

Associations Between Performance On An Abbreviated Cogstate Battery, Other Measures Of Cognitive Function, And Biomarkers In People At Risk For Alzheimer's Disease, Annie M. Racine, Lindsay R. Clark, Sara C. Berman, Rebecca L. Koscik, Kimberly D. Mueller, Derek Norton, Christopher R. Nicholas, Kaj Blennow, Henrik Zetterberg, Bruno M. Jedynak, Murat Bilgel, Cynthia M. Carlsson, Bradley T. Christian, Sanjay Asthana, Sterling C. Johnson

Mathematics and Statistics Faculty Publications and Presentations

It is not known whether computerized cognitive assessments, like the CogState battery, are sensitive to preclinical cognitive changes or pathology in people at risk for Alzheimer's disease(AD). In 469 late middle-aged participants from the Wisconsin Registry for Alzheimer's Prevention(mean age 63.8±7 years at testing; 67% female; 39% APOE4+), we examined relationships between a CogState abbreviated battery(CAB) of seven tests and demographic characteristics, traditional paper-based neuropsychological tests as well as a composite cognitive impairment index, cognitive impairment status(determined by consensus review), and biomarkers for amyloid and tau(CSF phosphorylated-tau/Aβ42 and global PET-PiB burden) and neural injury(CSF neurofilament light protein). CSF and PET-PiB …

Finding Chemopreventatives To Reduce Amyloid Beta In Yeast, Ian Macreadie, Costa Arvanitis, Prashant Bharadwaj

Research outputs 2014 to 2021

Alzheimer's disease (AD) is the most common form of age-related dementia with the latest report (WorldAlzheimerReport, 2015) showing 46.8 million people are currently affected by dementia. That number is expected to double every 20 years unless there is effective therapeutic intervention.

Developmental Transcription Factors In Age-Related Cns Disease: A Phoenix Rising From The Ashes?, Robert White, Meghan Thomas

Research outputs 2014 to 2021

Few would doubt that understanding the developmental landscape from which a mature neuron is derived is essential to understand its biology. The temporal and spatial position of a cell from the very earliest stages of development predicts the unique combinations of growth factors it will subsequently be exposed to. This combination of factors determines the transcriptional platform set within the cell by its specific combination of transcription factors, who direct the show. This, in turn, determines what cell type it will differentiate into, and what connections it will make. How this developmental platform translates to maintenance of a differentiated neuron …

Changes In The Plasma Proteome At Asymptomatic And Symptomatic Stages Of Autosomal Dominant Alzheimer's Disease, Julia Muenchhoff, Anne Poljak, Anbupalam Thalamuthu, Veer Gupta, Pratishtha Chatterjee, Mark Raftery, Colin Masters, John Morris, Randall Bateman, Anne Fagan, Ralph Martins, Perminder Sachdev

Research outputs 2014 to 2021

The autosomal dominant form of Alzheimer's disease (ADAD) is far less prevalent than late onset Alzheimer's disease (LOAD), but enables well-informed prospective studies, since symptom onset is near certain and age of onset is predictable. Our aim was to discover plasma proteins associated with early AD pathology by investigating plasma protein changes at the asymptomatic and symptomatic stages of ADAD. Eighty-one proteins were compared across asymptomatic mutation carriers (aMC, n = 15), symptomatic mutation carriers (sMC, n = 8) and related noncarriers (NC, n = 12). Proteins were also tested for associations with cognitive measures, brain amyloid deposition and glucose …

Aβ-Related Memory Decline In Apoe Ε4 Noncarriers: Implications For Alzheimer Disease, Yen Ying Lim, Simon Laws, Victor Villemagne, Robert Pietrzak, Tenielle Porter, David Ames, Christoher Fowler, Stephanie Rainey-Smith, Peter Snyder, Ralph Martins, Olivier Salvado, Pierrick Bourgeat, Christopher Rowe, Colin Masters, Paul Maruff

Research outputs 2014 to 2021

Objective:

As the absence of Aβ-related memory decline in APOE ϵ4 noncarriers may be due to the relative brevity of previous studies, we aimed to characterize Aβ-related cognitive decline over 72 months in APOE ϵ4 carriers and noncarriers who were cognitively normal (CN).

Methods:

CN older adults (n 423) underwent Aβ imaging and APOE genotyping. Participants completed comprehensive neuropsychological testing at baseline 18-, 36-, 54-, and 72-month assessments.

Results:

Relative to Aβ- CN ϵ4 noncarriers, both Aβ+ CN ϵ4 carriers and noncarriers showed significantly increased decline in measures of memory, language, and executive function as well as higher rates of …

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 …

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.

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.

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. …

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 …

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 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 …

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 …

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 …

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 …

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 …

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 …