Neurology Commons^™

Raising Awareness In South Punjab: The Importance Of Consulting Neurologists For Neurological Disorders, Muhammad Fahad Saleem, Mohammad Wasay, Sohaib Hassan, Muhammad Wahab Qureshi, Muhammad Hamza Khan, Muhammad Wazir

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Neurosurgery Research In Pakistan: An Analysis Of Publications, Citations, And Gender Disparities, Waseem Hassan

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Hope In The Face Of Subacute Sclerosing Panencephalitis: A Case Report Of Complete Remission With Isoprinosine, Nimra Shafique, Syed Muhammad Essa, Amanullah Kakar

Pakistan Journal of Neurological Sciences (PJNS)

Subacute Sclerosing Panencephalitis (SSPE) is a rare and relentless neurodegenerative disorder linked to persistent measles virus infection. We present a case of a 16-year-old female with gradually worsening rigidity, cognitive decline, and myoclonic seizures, minimally responsive to valproic acid. A history of measles infection at the age of two years emerged. Positive cerebrospinal fluid (CSF) IgG and IgM anti-measles antibodies, along with an elevated CSF/serum antibody index, confirmed SSPE. Treatment with Inosine pranobex and clonazepam yielded significant motor and seizure control improvements. This case highlights the importance of early SSPE diagnosis and tailored interventions, shedding light on clinical progression and …

Predictors And Prevention Of Neurological Disability In Adult Bacterial Meningitis: A Narrative Review With Clinical Perspective, Sadiq Ali Shah

Pakistan Journal of Neurological Sciences (PJNS)

Background and objective: Bacterial meningitis remains a neurological emergency in adults, with substantial mortality and long-term sequelae, including cognitive impairment, hearing loss, seizures, and focal deficits. The objective of this narrative review was to summarize current evidence on predictors of neurological disability and highlight strategies for prevention and long-term care.

Methods: A narrative literature review was conducted using PubMed, Scopus, and Google Scholar for English-language studies published between 2000 and 2025. Keywords included bacterial meningitis, neurological sequelae, predictors, and adults. A total of 40 studies were included after screening 200 abstracts . Key prospective studies, clinical trials, and reviews were …

Clinicoradiological Findings And Outcome Of Posterior Reversible Encephalopathy Syndrome In Children: A Cross-Sectional Study, Zia Ur Rehman Muhammad, Shaila Ali, Shumaila Rafiq, Javeria Raza Alvi, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective: Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterised by altered sensorium, seizures, visual impairment and behavioural changes. The objective of the study was to evaluate clinicoradiological findings and outcome of PRES in children.

Methods: A prospective cross-sectional study was conducted at department of pediatric neurology, the Children’s Hospital Lahore from October 2020 to September 2023. Clinical and demographic data were colllected on a structured proforma. Investigations comprised complete blood count, biochemistry, urinalysis, complement levels, inflammatory markers, immune panel, lipid profile and abdominal ultrasonography. All patients underwent MRI brain. Outcome was categorized as complete recovery or …

Spectrum Of Demyelinating Diseases In Pakistan: A Multicenter Cross-Sectional Study, Zainab Aslam Saeed Memon, Safia Awan, Haris Majid Rajput, Qamar Un Nisa, Muhammad Subhan, Lal Chand, Muhammad Wazir Ali Khan

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective: Demyelinating diseases are a heterogeneous group of disorders of the central nervous system, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and acute disseminated encephalomyelitis (ADEM). Data from South Asia remain scarce, despite potential regional variations in disease spectrum and outcomes. The objective of this study was to characterize the demographic, clinical, and disability profile of patients with demyelinating disorders across Pakistan.

Methods: This multicenter cross-sectional study was conducted between August 2017 and December 2019 across 39 neurology centers in Pakistan. Adult patients (≥18 years) diagnosed with demyelinating disorders using standardized criteria were included. Data on …

Down Syndrome In Africa: Challenges, Opportunities, And Future Directions, Eimear Mcglinchey, Salina Tewolde, Amanda He, Juan Fortea, Lingani Mbakile-Mahlanza, Ayda Tefera, Emmanuel Epenge, Jason Hassenstab, Rachel Maina, Zul Merali

Brain and Mind Institute

INTRODUCTION: As life expectancy improves for people with Down syndrome (DS) in Africa, the risk of developing DS-associated Alzheimer’s disease (DSAD) will rise. There is a pressing need to plan for this emerging challenge, particularly in the context of existing health and social disparities.

METHODS: This work emerged from a pan-African collaboration, including discussions at the Brain Ageing and Dementia in Low- and Middle-Income Countries conference held in Nairobi in 2024, where stakeholders identified regional priorities for DS and dementia care.

RESULTS: Limited epidemiological, cognitive, biomarker data, delayed diagnoses, and gaps in specialized services may impact access …

Socio-Medical Factors Associated With Neurodevelopmental Disorders On The Kenyan Coast, Patricia Kipkemoi, Jeanne E. Savage, Joseph Gona, Kenneth Rimba, Martha Kombe, Paul Mwangi, Collins Kipkoech, Beatrice Mkubwa, Amina Abubakar, Charles Newton

Institute for Human Development, East Africa

Neurodevelopmental disorders (NDDs) are a group of conditions with their onset during the early developmental period and include conditions such as autism and intellectual disability. Occurrence of NDDs is thought to be determined by both genetic and environmental factors, but data on the role of environmental factors for NDD in Africa is limited. This study investigates environmental influences on NDDs in children from Kenya. This case-control study compared children with NDDs and typically developing children from two studies on the Kenyan coast. We included 172 study participants from the Kilifi Autism study and 151 from the NeuroDev study who had …

Managing Refractory Epilepsy In A Resource Limited Setting—Doing More With Less, Ruta Yardi, Kurupath Radhakrishnan, Pauline Samia, Janet Wilson, Amza Ali

Paediatrics and Child Health, East Africa

Drug-resistant epilepsy (DRE) disproportionately affects individuals in low- and middle-income countries (LMIC), where access to affordable and effective care remains a significant challenge. Patients with DRE face high healthcare costs, inadequate access to epilepsy surgery, and limited availability of trained professionals. This review explores a multifaceted approach to managing DRE in resource-constrained settings. Key strategies include rational polypharmacy with cost-effective antiseizure medications (ASM), implementation of dietary therapies like the ketogenic diet, and cost-conscious presurgical evaluations. Enhancing emergency care systems, particularly for conditions like status epilepticus, is critical, as is the development of standardized diagnostic and treatment protocols and training programs …

Global Multi-Specialty Clinician Perspectives On The Implementation Of Alzheimer's Disease Blood Biomarkers, Joanne Rodda, Lindsey A. Kuchenbecker, Wyllians V. Borelli, Mari L. Demarco, Raphael M. Castilhos, Erin E. Cawston, Tinatin Chabrashvili, Melissa M. Budelier, Claudia Duran Aniotz, Chinedu Momoh

Brain and Mind Institute

Introduction: Clinicians' views on the clinical readiness of Alzheimer's disease (AD) blood biomarkers (BBMs) are not well understood.

Methods: The Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment Biofluid-Based Biomarkers Professional Interest Area conducted a survey to elicit clinician opinions on AD BBM implementation, including contexts of use, assay selection, reporting, and result interpretation.

Results: Clinician respondents (n = 212) practiced in Europe (56%), North America (24%), the Caribbean and Central/South America (11%), and other continents (9%). Most respondents were medical doctors (80%) practicing in secondary or tertiary care (88%). For 56%, cerebrospinal fluid AD …

Neurocognitive Gains Among Ugandan Children With Sickle Cell Anemia On Hydroxyurea: 18-Month Trial Interim Results, Shubaya Kasule Naggayi, Dennis Kalibbala, Vincent Mboizi, John M. Ssenkusu, Zhezhen Jin, Caterina Rosano, Deogratias Munube, Bill Wambaka, Ruth Namazzi, Robert Opoka

Paediatrics and Child Health, East Africa

Children with sickle cell anemia (SCA) frequently develop progressive neurocognitive impairment. We aimed to determine effects of hydroxyurea therapy on neurocognitive function in Ugandan children with SCA by comparing levels at enrollment to a planned 18-month interim assessment. Ugandan children (N=264) ages 3-9 years were enrolled from a SCA clinic and treated in a 30-month singlearm open-label trial with escalation to maximum tolerated dose (MTD). Primary outcome was the effects of hydroxyurea on cognition, attention and executive function, along with transcranial doppler ultrasound (TCD) blood flow velocity. Sibling controls (N=110) without SCA underwent neurocognitive testing in parallel to establish age-normalized …

Dementia In A Resource-Constrained Sub-Saharan African Setting: A Comprehensive Retrospective Analysis Of Prevalence, Risk Factors, And Management At The Only Neuropsychiatric Facility In Northeastern Nigeria, Ibrahim Abdu Wakawa, Umar Baba Musami, Suleiman Hamidu Kwairanga, Placidus Nwankuba Ogualili, Mohammed Yusuf Mahmood, Muhammad Abba Fugu, Mohammed Mala Gimba, Muktar Mohammed Allamin, Zaharadeen Umar Abbas, Chinedu Momoh

Brain and Mind Institute

INTRODUCTION: Dementia prevalence is increasing in sub-Saharan Africa, poten-tially due to population growth and aging. Resource-constrained settings such asNortheastern Nigeria face challenges in dementia management.

METHODS: We assessed dementia burden and management at the Federal Neuropsy-chiatric Hospital Maiduguri, the only neuropsychiatric facility in Northeastern Nigeria.This retrospective analysis included patient records from 1999 to 2023 for individuals60 year of age and older with a dementia diagnosis.

RESULTS: Of the 1216 cases reported, Alzheimer’s disease (60.5%) was the mostcommon subtype, followed by vascular dementia (24.5%). Hypertension (41.6%) wasthe most frequent comorbidity. Memory loss was present in all cases, whereasbehavioral …

Epidemiology Of Stroke And Risk Factors In Punjab, Pakistan: A Comprehensive Hospital-Based Study, Saima Ahmad, Adnan Khan, Fatima Gul Chaudhary, Haseeb Manzoor, Hira Jamil, Hamid Mahmood, Kausar Tayyab, Uchechukwu Levi Osuagwu

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective

Stroke is a significant global health challenge, particularly burdening low- and middle-income countries where it leads to substantial mortality and disability-adjusted life years. The objective of this study was to investigate the prevalence of stroke and its subtypes among adults in Pakistan's Punjab region.

Methods

This retrospective hospital-based study was conducted at Lahore General Hospital in Punjab, Pakistan, serving as the primary referral center for stroke cases. Medical records from January 2019 to December 2020 were reviewed using the International Classification of Diseases. A structured data collection form captured demographics, stroke types, risk factors, medical histories, and …

Electrodiagnostic Patterns In Neuromuscular Disorders: A Retrospective Cross-Sectional Study From A Tertiary Care Hospital, Ayisha Farooq Khan, Sajid Hameed, Dureshahwar Kanwar, Sara Khan

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective

Electromyography (EMG) and nerve conduction studies (NCS) are essential for diagnosing neuromuscular disorders and differentiating various peripheral nervous system conditions. The objective of this study was to assess the prevalence and trends of neuromuscular disorders based on EMG/NCS findings in a tertiary care center in Pakistan.

Methods

This retrospective cross-sectional study was conducted at the neurophysiology laboratory of Aga Khan University Hospital from 1st January 2023 to 31st December 2023. A total of 961 EMG/NCS records were analyzed, including both inpatient and outpatient cases. Data was extracted from the EMG registry, and findings were categorized into mononeuropathy, …

Clinical And Radiological Profile Of Patients Presenting With Neurolisteriosis: A Retrospective Study From A Tertiary Care Hospital, Zainab Memon, Muhammad Abdullah, Fatima Mubarak

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective

Neurolisteriosis, a central nervous system (CNS) infection caused by Listeria monocytogenes, is associated with significant morbidity and mortality, particularly in elderly and immunocompromised individuals. The objective of this study was to analyze the clinical and radiological data from the patients of this disease presenting to a tertiary care hospital.

Methods

This retrospective review analyzed clinical, laboratory, and neuroimaging data from 12 patients diagnosed with neurolisteriosis at Aga Khan University Hospital between September 2018 and March 2024. Diagnosis was confirmed through blood and/or cerebrospinal fluid cultures or polymerase chain reaction assays. Data was analyzed using Statistical Package for …

Houge-Janssens Syndrome-1 Associated With Protein Phosphatase 2 Regulatory Subunit B’ Delta And Epilepsy: A Case Report, Dua Saleem, Fizza Akbar, Noor Zeeshan, Rabab Jafry, Salman Kirmani, Sidra Kaleem Jafri

Pakistan Journal of Neurological Sciences (PJNS)

Houge-Janssens syndrome 1 is a rare autosomal dominant disorder with approximately 100 case reports worldwide. Here, we present a case of a Pakistani toddler who presented with epilepsy and developmental delay. Family history was significant with reported and documented developmental delays in both father and elder sister, with subsequent improvement. Trio-whole-genome sequencing (WGS) and Sanger sequencing were performed, revealing a heterozygous LP variant NM_006245.4: c.626A>C, p.(His209Pro) in the girl. The same variant was also identified in her father and sister. This case sheds light on the variability of phenotypic expression amongst affected individuals and recommends the need for further …

High Dose Methylprednisolone In Children With Severe Headache In Viral Encephalitis: A Case Series, Abia Abdullah, Jay Kumari, Prem Chand

Pakistan Journal of Neurological Sciences (PJNS)

Severe headache is a common symptom in children with viral encephalitis (VE), yet effective symptom-specific therapies are limited. In this case series, we present three children of ages 15, 14, and seven diagnosed with VE who presented with severe headaches unresponsive to standard analgesics but showed significant clinical improvement following high-dose methylprednisolone therapy. Although this is not first line treatment, these cases suggest a possible role for methylprednisolone in alleviating severe VE-associated headaches. Further controlled studies are needed to establish its effectiveness and safety in such settings.

Acute Flaccid Myelitis Caused By Enterovirus Infection- A Case Report, Ahmad Bilal, Tipu Sultan, Zia Ur Rehman, Arshad Mehmood, Amber Shabir, Javeria Raza

Pakistan Journal of Neurological Sciences (PJNS)

Enterovirus is a member of the Picornaviridae family, an enterovirus. It is suspected of causing a polio-like disorder called acute flaccid myelitis (AFM). This case report aims to present a 10-year-old boy who presented with neurological manifestations of weakness of lower limbs and urinary retention. He had reduced tone, absent reflexes, and palpable bladder. MRI spine revealed inflammation in grey matter of spinal cord. He was treated with high dose steroids and IVIG but no improvement was observed. Enterovirus was isolated from his stool sample. The patient received supportive care and physiotherapy with gradual improvement after months, having no evidence …

Blood Biomarkers In Down Syndrome: Facilitating Alzheimer's Disease Detection And Monitoring, Melissa Petersen, Lisi Flores-Aguilar, Elizabeth Head, Laia Montoliu-Gaya, Andre Strydom, Sarah Pape, Juan Fortea, Nicholas Ashton, Chinedu Momoh, Sid O'Bryant

Brain and Mind Institute

Blood-based biomarkers continue to be explored for disease detection, monitoring of progression, and therapeutic outcomes as the diagnostic determination of Alzheimer's Disease in Down Syndrome (DS-AD) remains challenging in clinical settings. This perspective highlights the current status of this effort. Overall, amyloid (A), tau (T), and neurodegeneration (AT[N]) blood-based biomarkers have been shown to increase with disease pathology for individuals with DS. Phosphorylated tau biomarkers (p-tau217, p-tau181) have been consistently shown to track disease progression for DS-AD and are likely good candidates for use in clinical settings. Biomarkers of inflammation (glial fibrillary acidic protein) also show promise; however, additional work …

Burden Of Vascular Neurological Disorders: A Cross-Sectional Multicenter Study, Shafaq Saleem, Safia Awan, Ibrar Rafiq, Muhammad Hassan Shaikh, Anjum Farooq, Maimoona Siddiqui, Zainab Aslam Saeed Memon, Alam Ibrahim Siddiqui

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective

Stroke remains a leading cause of morbidity and mortality worldwide, with a particularly high burden in low- and middle-income countries (LMICs) such as Pakistan. Despite its growing prevalence, limited nationwide data exist on vascular diseases, their risk factors, and disability outcomes. The objective of this study was to identify the frequency and age-stratified type of vascular disease incidence among in-patient hospital admissions.

Methods

A retrospective observational study was conducted across 39 neurology centers in Pakistan, spanning both public and private sectors from August 2017 to December 2019. Data on demographics, comorbidities, and stroke type were systematically collected …

Electrographic Significance Of Periodic Discharges And Association With Etiology And Outcome In A Tertiary Care Hospital: A Retrospective Cohort Study, Hina Imtiaz, Zainab Memon, Ayisha Farooq Khan, Dureshahwar Kanwar, Safia Awan

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective

Periodic discharges on electroencephalograms (EEGs) are rhythmic waveforms that may indicate acute or subacute brain injury. This aim of this study was to determine the frequency distribution of periodic discharge subtypes on EEG and to assess their association with underlying etiologies and clinical outcomes in a tertiary care hospital.

Methods

This retrospective observational cohort study included neurological patients aged ≥18 years admitted to the medical ICU or ward of Aga Khan University Hospital between January 1, 2021, and January 1, 2023, with periodic discharges on EEG. Patients with prior traumatic brain injury were excluded. Data on demographics, …

Epilepsy In Pakistani Adolescents Amid The Vaping Epidemic, Maheen Kalwar, Eisha Tur Raazia, Harmain Naz Shaikh

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

New Onset Seizures Evolving Into Refractory Status Epilepticus In The Setting Of Covid-19: A Case Report, Mahira Mushtaq, Zuha Amin, Shafaq Saleem, Fowzia Siddiqui

Pakistan Journal of Neurological Sciences (PJNS)

The novel Coronavirus disease (COVID-19) has been shown to involve the nervous system (both central and peripheral), with or without respiratory involvement in multiple ways. Although not much is known about this disease yet, seizures and status epilepticus which may evolve into refractory status epilepticus have been associated with it along with other manifestations like encephalopathy, neuropathies etc. The mechanism for development of seizures with COVID-19 related disease is not entirely known however it can be the consequence of “cytokine release syndrome” or “cytokine storm” which has been associated with this virus. Patients with COVID-19 infection who develop resistant status …

Pakistan Ischemic Stroke Guidelines, Anjum Farooq, Maria Khan, Ayesha Zafar, Husnain Hashim, Fozan Khan, Abdul Malik, Ayeesha Kamran Kamal Aga Khan University, Karachi, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is the second leading cause of death and disability. Mortality related to stroke is very high in low- and middle-income countries. Stroke imposes a great socioeconomical burden in Pakistan. It is important to take important steps for prevention and proper management of stroke in country. Purpose of developing stroke guidelines is to improve stroke care in Pakistan. Guidelines are designed to help neurologists and general practitioners for treating stroke. American stroke guidelines, NICE guidelines, Canadian guidelines and multiple important articles including those emphasizing stroke care in low- and middle-income countries were studied, and these current guidelines were designed in …

Focused Ultrasound: A New Era In Tremor Control, Sajid Hameed

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Tocilizumab In The Management Of Neuromyelitis Optica Spectrum Disorder: A Narrative Review Of Literature And Critical Appraisal, Salman Mansoor, Samar Iltaf Mairajuddin, Saqib Gul

Pakistan Journal of Neurological Sciences (PJNS)

Background and objective

Neuromyelitis Optica Spectrum disorder (NMOSD) mostly affects the spinal cord and optic nerves. This manuscript aims to explore the treatment potential of tocilizumab, a monoclonal antibody that targets the interleukin-6 (IL-6) receptor and regulates inflammatory cytokines implicated in the pathophysiology of NMOSD. Methods

A thorough search of the pertinent literature was done for this research utilising electronic databases, specifically PubMed, Cochrane Library, and Embase, which contained studies published from 2016 to 2024.

Results Clinical studies show that tocilizumab improves clinical outcomes and lowers recurrence rates in people with NMOSD, especially those who don't respond to traditional treatments. …

Chorea As A Rare Manifestation Of Neuropsychiatric Systemic Lupus Erythematosus: A Case Report, Qurat Ul Ain, Ashfeen Ishfaq, Farzana Kouser, Rabia Rasool

Pakistan Journal of Neurological Sciences (PJNS)

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with multisystemic involvement. It has variable clinical presentations and a relapsing and remitting course. Clinical manifestations are broad, ranging from mild mucocutaneous involvement to major organ involvement. We present a case of a 32-year-old female with repeated movements of the right arm, and confusion with a background of pains in multiple joints. She was diagnosed as a case of Neuropsychiatric Systemic Lupus Erythematosus (NPSLE). She was managed with pulse therapy of cyclophosphamide (CYC) along with other supportive medications. After six months of intensive immunosuppressive therapy, she remained well and continued maintenance …

An Expansion Of The Phenotype In Individuals With Syncrip-Related Neurodevelopmental Disorder, Tooba Shafiq, Joanna Feng, Lindsay Phillips, Kara Murias, Marcia Ferguson, Kristin Baranano, Alaina Acchione, Patricia Kipkemoi, Collins Kipkoech, Amina Abubakar

Institute for Human Development, East Africa

Disruption of genes within the HNRNP gene family has been observed in neurodevelopmental and neurodegenerative diseases. The HNRNP-Related Neurodevelopmental Disorders (HNRNP-RNDDs), while each unique, have been recently described with similar clinical and molecular features across variation in several genes. However, the phenotypic information on these patients is still lacking. In this case series we aim to describe the phenotypes that are associated with SYNCRIP-Related Neurodevelopmental Disorder (SYNCRIP-RNDD). We describe in depth ten novel individuals and one previously published individual with mostly de novo and predicted damaging variants in SYNCRIP, consistent with a diagnosis of SYNCRIP-RNDD. We also describe previously published …

Removing Lead From The Global Economy, Stephen P. Luby, Jenna E. Forsyth, Zafar Fatmi, Mahbubur Rahman, Jesmin Sultana, Erica L. Plambeck, N Grant Miller, Eran Bendavid, Peter J. Winch, Howard Hu

Community Health Sciences

No abstract provided.

Considerations For Widespread Implementation Of Blood-Based Biomarkers Of Alzheimer's Disease, Michelle Mielke, Matthew Anderson, Wesson Ashford, Andreas Jeromin, Pei-Jung Lin, Allyson Rosen, Jamie Tyrone, Lawren Vandevrede, Deanna Willis, Zul Merali

Brain and Mind Institute

Diagnosing Alzheimer's disease (AD) poses significant challenges to health care, often resulting in delayed or inadequate patient care. The clinical integration of blood-based biomarkers (BBMs) for AD holds promise in enabling early detection of pathology and timely intervention. However, several critical considerations, such as the lack of consistent guidelines for assessing cognition, limited understanding of BBM test characteristics, insufficient evidence on BBM performance across diverse populations, and the ethical management of test results, must be addressed for widespread clinical implementation of BBMs in the United States. The Global CEO Initiative on Alzheimer's Disease BBM Workgroup convened to address these challenges …