Medical Specialties Commons^™

Temporal Lobe Epilepsy With Hippocampus Sclerosis: Prevalence, Etiology, And Treatment Options With Herbal Medicines, Muhammad Wasim, Mehr Musani, Hasan Salman Siddiqi, Saara Muddasir, Bushra Amin, Fazal Manzoor Arain

Pakistan Journal of Neurological Sciences (PJNS)

Background and objectives: Epilepsy is a neurological disorder in which the patient suffers with two or more unprovoked seizures. It is one of the most common neurological disorders worldwide, affecting more than 70 million people. Currently various modes of effective treatments are available, but still there are many cases that remain drug resistant. Hence, there is a need to explore herbal medications for the treatment of drug resistant epilepsy.

Methods: Recent reviews and research articles (2000-2022) from PubMed and Google Scholar have been explored.

Review: Based on etiology, there are six categories of epilepsy: Genetic, Structural, Metabolic, Immune, Infectious, and …

Predictors Of Early Seizures After First Acute Stroke, Malik Muhammad Adil, Sumaira Nabi, Maryam Khalil, Zeeshan Munawar, Nayab Aslam, Zaid Waqar

Pakistan Journal of Neurological Sciences (PJNS)

Background and objective: There is a lack of local data regarding the frequency and predictors of early seizures after stroke. The objective of this study was to determine the frequency of early seizures after stroke and identify the predictors which lead to them after first acute stroke.

Methods: This cross-sectional observational study was conducted in the Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad from October 2021 to June 2022. A total of 310 consecutive eligible patients of acute stroke were recruited. Key inclusion criteria included any patient of >20 years of age with confirmed diagnosis of stroke on …

Hypodensities Within Hematoma Predict Outcome After Spontaneous Intracerebral Hemorrhage, Maryam Khalil, Sumaira Nabi, Amjad Mahmood Khan, Zeeshan Munawar, Samar Naik, Zaid Waqar, Malik Muhammad Adil, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Background and objective: Radial nerve is injured due to a variety of reasons. The objective of this study was to determine the clinical spectrum, risk factors and electrophysiologic aspect of radial nerve injury presenting to a tertiary care hospital in Lahore.

Methods: This descriptive prospective cross-sectional study was conducted at department of Neurology, Mayo hospital Lahore from July 2022 to December 2022 and comprised patients with isolated radial nerve injury on the basis of history and clinical examination regardless of their gender, above 15 years of age. NCS/EMG was done on a Japanese machine Nihon Kohden by an expert as …

Experience With Anti Nmda Receptor Antibody Encephalitis In A Tertiary Care Hospital In Pakistan, Haris Majid Rajput, Zaid Waqar, Muhammad Hassan, Neelma Naz Khattak, Umair Hassan, Iqra Athar, Mazhar Badshah Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Background and objective: Anti NMDA receptor (Anti-NMDAR) antibody encephalitis is an increasingly recognized form of auto immune encephalitis. The objective of this study was to determine the demographic, clinical and laboratory factors associated with this syndrome.

Methods: All cases presenting to neurology, Pakistan institute of medical sciences, Islamabad, from June 2017 till January 2020 were reviewed retrospectively. Patients fulfilling the diagnostic criteria for Anti NMDA receptor (Anti-NMDAR) antibody encephalitis were included. All patients were evaluated with cerebrospinal fluid (CSF)routine examination, MRI brain, autoimmune encephalitis profile and for presence of oligoclonal bands (OCB) in CSF. Statistical analysis was done using SPSS …

Anti-Nmda Receptor Encephalitis Presenting With Severe Episodic Hypertension: A Case Report, Tehreem Arshad, Musarrat Hussain, Abdul Wahab Yousafzai, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

Anti-N-methyl-D-aspartate receptor (Anti-NMDAR) encephalitis is one of the most commonly emerging autoimmune encephalitis in children and young adults in recent years. Clinical manifestations range from prodromal symptoms to seizures, movement disorder, psychiatric manifestations, cognitive/speech impairment, and autonomic dysfunction. Our case presented with initial symptoms of severe episodic hypertension, sweating, agitation, and tachycardia. She received early care for pheochromocytoma and panic disorder in Qatar, but there was no relief. Three weeks later, she presented in our emergency room with seizures, cognitive/speech impairment, and orofacial dyskinesia. Electroencephalography (EEG) revealed right hemispheric delta activity and cerebrospinal fluid CSF anti-NMDA Receptor IgG was positive. …

Clinical Spectrum, Risk Factors And Electrophysiologic Aspect Of Radial Nerve Injury, Arfah Kanwal, Safia Bano, Ubaid Ullah, Ahsan Numan

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT

Background and objective: Radial nerve is injured due to a variety of reasons. The objective of this study was to determine the clinical spectrum, risk factors and electrophysiologic aspect of radial nerve injury presenting to a tertiary care hospital in Lahore.

Methods: This descriptive prospective cross-sectional study was conducted at department of Neurology, Mayo hospital Lahore from July 2022 to December 2022 and comprised patients with isolated radial nerve injury on the basis of history and clinical examination regardless of their gender, above 15 years of age. NCS/EMG was done on a Japanese machine Nihon Kohden by an expert …

Multiple Sclerosis In Pakistan: Collaborative Working To Improve Care, Sarah Razaq, Fahim Anwar

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Retraction Notice, Editorial Team Pjns

Pakistan Journal of Neurological Sciences (PJNS)

Retraction Notice

Khan MI, Khan JI, Ahmed SI, Ali S. The epidemiology of stroke in a developing country (Pakistan). Pak J Neurol Sci. 2018;13(3):30-44.

A reader brought to our attention that the article titled “The epidemiology of stroke in a developing country (Pakistan)”, published in Volume 13, Issue 3, of Pakistan Journal of Neurological Sciences (PJNS) was a redundant (duplicate) publication. We investigated this complaint and found out that prior to its submission to PJNS on February 11 2018, this article had already been published almost verbatim in Journal of Neurology & Stroke on January 23, 2018.

Churg Strauss Syndrome With Neuropathy: A Case Report, Zaid Waqar

Pakistan Journal of Neurological Sciences (PJNS)

A 24 years old man with known history of asthma came with acute presentation of ascending weakness for four days following flu like symptoms and worsening of asthma. His complete blood counts showed elevated eosinophil count. Nerve conduction showed neuropathy. He was diagnosed as Churg Strauss syndrome due to presence of asthma, eosinophilia, neuropathy and pulmonary infiltrates. Churg Strauss is a systemic eosinophilic vasculitis involving multiple organ systems that may present with neuropathy, as in this case.

Post Covid-19 Vaccine (Sinovac) Cerebral Venous Sinus Thrombosis, Soban Khan, Maryam Khalil, Zaid Waqar

Pakistan Journal of Neurological Sciences (PJNS)

SINOVAC is an inactivated virus COVID 19 vaccine given emergency authorization for COVID-19 Pandemic. Different adverse reactions have been seen in after-marketing of COVID-19 vaccines. Here we present a case of patient who developed cerebral venous sinus thrombosis two weeks after the first dose of SINOVAC vaccine.

Molecular Analyses Of Phenylketonuria In The Intellectually Disabled Children From Faisalabad, Punjab, Pakistan, Habiba Hussain, Muhammad Wasim, Haq Nawaz Khan, Hina Ayesha, Fazli Rabbi Awan

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT Background and Objective: Phenylketonuria (PKU) is a rare inherited metabolic disorder, caused by mutations in the phenylalanine hydroxylase (PAH). It is a treatable disorder if diagnosed earlier in life. The objective was to identify PKU patient(s) amongst the intellectually disabled children. Methods: Blood samples (n=100) were collected from intellectually disabled children from Faisalabad, Pakistan. Screening was performed on plasma samples through High Performance Liquid Chromatography (HPLC), and DNA samples were examined for mutation analysis of PAH through direct PCR and SSCP analyses. Results: In the current study, 85% consanguinity rate was observed, with the average BMI (16.15 kg/m2) and …

Prevalence Of Depression In Caregivers Of Stroke Patients In Karachi, Pakistan, Marium Mansoor, Shahina Pirani, Rabeeka Aftab, Tania Nadeem

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT Background and Objective: Caregivers of patients with chronic debilitating illnesses are at risk of developing mental health problems. The objective of this study is to determine the frequency of depression in caregivers of stroke patients at a tertiary care teaching hospital in Karachi, Pakistan. Methods: A cross-sectional study was conducted among caregivers of stroke, who were recruited from the Aga Khan University Hospital between January 2018 to October 2018. Data was collected through the Urdu Hamilton rating scale for depression (HAM-D-U) and it was analyzed using descriptive and inferential statistics. Results: A total of 136 caregivers participated in the …

Practical Measures For Disabled’S Empowerment-Time For Economic Growth!, Mahnoor Hafeez

Pakistan Journal of Neurological Sciences (PJNS)

The objective of this article is to advocate for persons with disabilities’ (PWD) rights, to discuss issues solutions, social awareness and to promote diversity and inclusion. The word ‘Disability’ covers a wide range of irreversible permanent impairments including physical and mobility difficulties, hearing, visual impairment, specific learning disabilities including dyslexia, medical conditions and mental health problems that may hinder their full and effective participation in society on an equal basis with others.1 Handicap is the condition of being unable to perform due to physical or mental unfitness.

Post Covid-19 Vaccine Guillain Barre Syndrome, Soban Khan, Maryam Khalil, Zaid Waqar, Sajid Khan, Zakir Jan

Pakistan Journal of Neurological Sciences (PJNS)

The Guillain Barre Syndrome (GBS) is an acute immune-mediated progressive polyneuropathy having an acute monophasic illness leading to paralysis. The clinical features are progressive ascending symmetrical muscle weakness that may lead to respiratory failure. Diagnosis is based upon clinical presentation and is supported by a lumbar puncture with CSF analysis demonstrating albumin-cytological dissociation, and electrophysiological studies. Our patient presented to us with progressive ascending paralysis after receiving COVID 19 vaccine.

Succinic Semialdehyde Dehydrogenase Deficiency – A Rare Cause Of Metabolic Stroke, Areeba Wasim, Javeria Raza Alvi, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Succinic semialdehyde dehydrogenase (SSADH) deficiency is a rare neurometabolic disorder characterized by defective degradation of gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter of the brain. Children with SSADH deficiency present with motor and mental delay, intractable seizures, infantile onset hypotonia, speech disturbances, extrapyramidal symptoms and ataxia. This wide spectrum results from increased accumulation of 4hydroxy butyric acid (4HBA) leading to down regulation of GABA receptors, which likely explain epileptogenesis but the pathophysiology of stroke in SSADH deficiency is not much elucidated. Here, we report an infant aged 11 months, product of consanguineous marriage with significant family history of motor delay …

Risk Factors Of Intracerebral Hemorrhage – A Cross Sectional Study, Mir Jalal-Ud-Din, Raheel Jehangir Jadoon, Syed Affan Ali, Samia Wazir Khawaja, Zahid Gul Jadoon, Ibtisam .

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT Background and Objective: Stroke is the major cause of disability and one of the top causes of death in the globe. Though the rate is decreasing in the West, it is most likely growing in Asia. In Pakistan, the burden of stroke risk factors is substantial. Although data on the incidence and prevalence of stroke in Pakistan is limited, there are several published case studies demonstrating major disparities in stroke epidemiology, risk factors, kinds, and patterns. This study aims to identify risk factors of intracerebral hemorrhage among patients presenting to a teaching hospital. Methods: From August 2019 to February …

Iranian Stroke Model-How To Involve Health Policymakers, Mehdi Farhoudi, Ehsan Sharifipour

Pakistan Journal of Neurological Sciences (PJNS)

Stroke in Iran, with more than 83 million population, is a leading cause of disability and mortality in adults. Stroke has higher incidence in Iran comparing the global situation and unfortunately the onset age of first ever stroke is dropping about 10 years.1 Intravenous thrombolysis, as an approved treatment in ischemic stroke, has been used only in some university or private hospitals in Iran since 2008.2 The main limit for this therapy in Iran was the lack of coverage by health insurance companies for tPA. A project for situation analysis of stroke cases entering to Imam Reza Hospital, a tertiary …

Misperception About Epilepsy Among Common Public In Balochistan, Muhammad Essa, Gulandam ., Saleem Barech, Amanullah Kakar, Ihsan-Ul-Haq Zarkon, Suhail Mari, Muhammad Dawood, Tahir Shah

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT Background and Objective: Epilepsy is a treatable chronic neurological illness that is frequently associated with supernatural activity. The objectives of this study were to determine common myths and misperception about epilepsy by analysing a comprehensive panel of variables in our local population. Methods: We conducted a face-to-face questionnaire interview survey in three different shopping malls. One thousand people were randomly enrolled in this cross-sectional study at Quetta, Baluchistan, during the period of 21 august 2021 to 30 august 2021.

Results: A total of 1000 people were interviewed; among them 220(22%) were male and 780(78%) were female. Individuals between the …

Screening For Depression And Anxiety Among Medical And Dental Students Who Are Forced Into Their Field Of Study, Sohail Ahmed Khan, Asvad Ahmad Khan, Asiyah Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT Background and Objective: The study hypothesized that the students who are forced to enter the medical field by their parents may have a higher incidence of depression and anxiety.

Methods: A total of 210 medical and dental students were asked to fill out a form indicating their desire to enter medical college versus their parents’ wishes on an analogue scale. They were also asked to fill out screening forms for depression and anxiety.

Results: The students who selected the medical field by their parent’s wishes were found to have 1.2 times more anxiety & 1.96 times more depression. Conclusions: …

Prolonged Psychosis Before Onset Of Neurological Symptoms: An Atypical Clinical Manifestation Of Huntington’S Disease, Marium Mansoor, Nida Rahman Khan, Alviya Shaique

Pakistan Journal of Neurological Sciences (PJNS)

Huntington's disease (HD) is a rare, autosomal dominant, progressive neurodegenerative disorder. HD manifests with a triad of progressive motor, cognitive, and psychiatric symptoms. Our patient was a 39-years-old married female with over a nine-year history of psychotic symptoms. The patient was diagnosed and treated for schizophrenia. Over the last 2-3 years, the patient had a progressive decline in her Activities of Daily Living, instrumental activities of daily living, and psychotic symptoms. She developed slurred speech, gait disturbances, frequent falls, involuntary movements of the trunk and distal extremities, bowel and bladder incontinence, and severe weight loss. Her genetic test for Huntington’s …

A Case Of Ulcerative Colitis Presenting With Cerebral Venous Thrombosis, Zaid Waqar

Pakistan Journal of Neurological Sciences (PJNS)

Ulcerative Colitis is an autoimmune inflammatory bowel disease causing abdominal pain, bloody diarrhea and malnutrition and is associated with intestinal and extra intestinal complications. The clinical course has remissions and flare ups. Thromboembolism is a known risk associated with ulcerative colitis. Here we present a case of a young man who presented with a flare up of ulcerative colitis and developed neurological deficits that were diagnosed as due to cerebral venous thrombosis. Cerebral venous thrombosis is a rare complication of ulcerative colitis and can be missed without proper work up and consideration of diagnosis.

Post Covid Anti-Nmdar Encephalitis In An Adolescent Girl, Javeria Raza Alvi, Muhammad Haider Sultan, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Anti-N-Methyl D-aspartate receptor (NMDAR) encephalitis is a neuro-inflammatory disorder caused by antibodies targeting neurons in the central nervous system. Certain viruses break immune tolerance of neuronal proteins and increase the permeability of blood brain barrier (BBB) to antibodies resulting in post infectious autoimmunity. We report a case about a 13 years old girl diagnosed as a case of anti-NMDAR encephalitis, who presented with psychiatric symptoms followed by abnormal movements and encephalopathy, with later development of autonomic instability with tachycardia and blood pressure at 98th centile. Her thyroid profile initially showed hyperthyroidism with negative anti-thyroid antibodies with subsequent normalization without anti-thyroid …

Stroke: Are Women Worse Off?, Maria Khan

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is a leading cause of death and disability worldwide. Although the age standardized rates of stroke have fallen, the absolute number of strokes continue to rise, particularly in the low and middle income countries. It was long recognized that women have a lower age-standardized incidence of stroke. This understanding has been challenged by the Global burden of Disease Study 2019 which highlights that although the total number of Disability Adjusted Life Years (DALYs) from stroke were higher in males compared to females, the number of incident and prevalent strokes were higher in females. In addition, the study did not …

World Brain Day- Brain Health For All, Safa Younis

Pakistan Journal of Neurological Sciences (PJNS)

World Brain Day is celebrated annually on July 22nd, and this year’s theme was “Brain Health for All”. In honor of World Brain Day, Aga Khan University, in collaboration with the World Federation of Neurology, hosted an international webinar moderated by Dr. Shafaq Saleem. Dr. Mohammad Wasay commenced the session by discussing the importance of WHO’s adoption of the Intersectoral Global Action Plan on epilepsy and other neurological disorders. He discussed how significantly this 10-year action plan will improve neurological training, awareness, and advocacy. He explained how this webinar would unpack problems related to neurological care in different parts of …

Multiple Sclerosis Care In Pakistan; Analysis Of Data Presented At First Paktrims Conference, Zara Shah, Haris Majid, Sadia Nishat, Sumera Rafat Umer, Sundus Mehtab Shafee, Ahmed Wali, Naila Shahbaz

Pakistan Journal of Neurological Sciences (PJNS)

Novel data on Multiple Sclerosis (MS) in Pakistan from leading institutes in the country was presented at the first Pakistan Treatment in Multiple Sclerosis (PAKTRIMS) Conference, organized by the section of Neurology, department of Medicine, Aga Khan University, Karachi on Saturday, December 18, 2021. Pakistan has been considered to have a low prevalence of MS; however, recent research reveals that it is not as uncommon as previously believed to be in the country. The true prevalence and incidence of MS in the country is unknown because of dearth of research. Data of MS patients enrolled in various private and public …

The Truth About Brain Cells: Is Adult Neurogenesis Possible?, Ekene Nnagha, Queen-Helen Egbai, Ahtesham Khizar

Pakistan Journal of Neurological Sciences (PJNS)

Brain cells regeneration involves renewal and repair of neurons and other cells in the brain, with restoration of their functions. Although this phenomenon was thought to end in early childhood, research has proven that adult neurogenesis is highly possible with some limitations. Regeneration of axons in the central nervous system is very slow and more complicated than neuronal regeneration, especially regeneration of peripheral nerves. Brain cell regeneration in the adult brain can help in recovery of damaged brain cells and correct cellular and brain tissue dysfunction that are commonly seen in some neurological disorders such as Stroke, Traumatic Brain Injury …

Clinical Spectrum And Eeg Findings Of Non-Convulsive Status Epilepticus In Children, Shaila Ali, Natasha Ghani, Ather Khalily, Zia-Ur- Rehman, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT

OBJECTIVE:

To determine the clinical spectrum and EEG findings ofnon-convulsive status epilepticus in children. METHODS: A total of 38 children were included in this prospective cross sectional study, having EEG suggestive of NCSE after taking informed consent from guardians, keeping EEG as gold standard tracings were reviewed according to criteria of non-convulsive status epilepticus. Their clinical features were also noted leading to non- convulsive status epilepticus. Diagnostic workup will be done to find out the underlying cause, according to the suspected etiology of non-convulsive status epilepticus.

RESULTS: There were 26 male and 12 female patients, with ratio of 2:1. …

Frequency And Types Of Cerebral Infarctions On Brain Imaging In 2257 Hospitalized Patients With Covid-19, Raima Kaleemi, Zainab Rauf, Muhammad Azeemuddin, Muhammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT BACKGROUND AND OBJECTIVE:

SARS-COV (COVID-19) virus is not solely a pulmonary disease but affect multiorgan system including the brain. The objective of this study was to see the frequency of neuroimaging findings especially cerebral infarcts in our covid population. METHODS: This study is a retrospective observational study conducted in a large tertiary care hospital which was also a Covid center from March 1, 2020 to December 30, 2020.The frequency of neurological manifestations in COVID19 positive patients admitting in the hospital was observed through charts review. All scans were reviewed by two trained neuroradiologists. RESULTS: Total of 2257 patients enrolled …

Artificial Intelligence And Neurology - Opportunities And Challenges In Pakistan, Adeel A. Memon, Junaid S. Kalia

Pakistan Journal of Neurological Sciences (PJNS)

The field of artificial intelligence (AI) has undergone rapid development in neurological disorders over the past few decades. AI relies on large volumes of high-quality data. As a result, their use in low-resource settings has been limited due to the lack of a digitized health care system. This article will address the challenges and opportunities involved in implementing AI for neurological care in Pakistan, as well as discuss the types of digital health care data and the benefits of applying AI in resource-limited countries

The Constellation Of Centronuclear Myopathy And Craniofacial Dysmorphism, Mahnoor Hafeez

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT:

A 20 years old third-year MBBS female student from Dow Medical College in 2008 presented to the Neurology Dept. in Karachi with a short history of rapidly worsening bilateral lower limb weakness for 6 months. There was facial dysmorphism. Motor neuron disease was the suspicion; EMG/NCS study revealed non inflammatory myopathic process involving all limb muscles; Centro nuclear myopathy (CNM) was diagnosed via muscle biopsy. CNM is a group of congenital myopathies, where cell nuclei are abnormally located in skeletal muscle cells. Craniofacial dysmorphism is characterized by abnormal development of facial and skull structures. To the best of the …