Neurology Commons^™

Dose Adjustment Of The Anti-Seizure Medications Levetiracetam And Lamotrigine During The Postpartum Period. Schedule Plan, Safety And Efficacy, Nadejda Khmelev, Firas Fahoum, Lilach Goldstein

Department of Neurology Faculty Papers

INTRODUCTION: Lamotrigine (LTG) and Levetiracetam (LEV) are anti-seizure medications (ASMs) widely used for treatment of women with epilepsy (WWE) of childbearing age due to low teratogenic potential. Physiological changes during gestation results in enhanced clearance. Drug level monitoring and frequent dose adjustments are required to avoid decline in serum levels and compromised seizure control. Postpartum, physiological changes reverse and ASM clearance trends back to pre-pregnancy rate. Rapid metabolic changes make drug level monitoring and dose adjustments challenging. A delay in dose decrement could result in toxicity. The optimal postpartum dose reduction rate hasn't been established.

METHODS: We retrospectively examined medical …

A Nationwide Registry Study Of Surgical And Patient-Reported Outcomes Following Anterior Cervical Discectomy And Fusion: Part 2 - Cage With Versus Without Local Bone Graft, Daniel De Wilde, Victor Gabriel El-Hajj, Patrick Vigren, Victor E. Staartjes, Elias Atallah, Erik Edström, Adrian Elmi-Terander

Department of Neurosurgery Faculty Papers

BACKGROUND: Local bone grafts are commonly used as filling material in cages during anterior cervical discectomy and fusion (ACDF). Alternatively, cages without filling materials can be used. The literature comparing these approaches is limited, and their respective effects on patient-reported outcomes (PROM) have been scarcely studied. This study was conducted to compare surgical outcomes and PROMs between local bone graft-packed cages and empty cages in ACDF surgery.

METHODS: This observational study utilized data from the Swedish nationwide registry, Swespine. All adults who underwent ACDF between 2006 and 2020 were considered for inclusion. Exclusion criteria included missing baseline or outcome data. …

Comprehensive Analysis Platform To Understand, Remedy, And Eliminate Amyotrophic Lateral Sclerosis (Capture Als): Study Protocol For A Canadian Multicenter, Multimodal, Longitudinal Observational Study, Natalie Saunders, Claire Magnussen, Hyungmo Kang, Mathieu Blais, Harpreet Bhinder, Gerald Pfeffer, Shelagh K. Genuis, Liziane Bouvier, Tanushka Anand, Tania M. Bubela

Office of the Provost

Background: The marked heterogeneity of Amyotrophic Lateral Sclerosis (ALS) combined with a lack of biomarkers are key contributing factors to the lack of disease-modifying treatments. The Comprehensive Analysis Platform to Understand Remedy and Eliminate ALS (CAPTURE ALS) is a Canadian platform designed to create the most comprehensive picture of people living with ALS with the objective of facilitating ALS research initiatives worldwide.
Objectives: The main aims of CAPTURE ALS include: (1) to characterize ALS and healthy controls with biosamples and data in order to provide the most comprehensive picture of individuals living with ALS to date; (2) to create a …

The Perspectives And Experiences Of Prospective Parents Declining Diagnostic Prenatal Genome Sequencing In Continuing Pregnancies With Fetal Structural Anomalies, Lisa S Weingarten, Allison Rosenbaum, Jessica De Voest, Stephanie Galloway, Jessica L Giordano, Samantha Stover, Lauren E Westerfield, Grant Bonesteele, Kelly L Gilmore, Leandra Tolusso, Beatrix Wong, A Theresa Wittman, Daniel T Swarr, Nancy Leslie, Anthony Johnson, Ignatia B Van Den Veyver, Neeta L Vora, Rebecca G Clifton, Aaron B Caughey, Ronald J Wapner, Wendy K Chung

Duncan NRI Faculty and Staff Publications

Objective: This study evaluates an understudied perspective: the experiences of prospective parents who decline prenatal genome sequencing (pGS) for continuing pregnancies with fetal structural anomalies.

Method: We recruited a total cohort of 300 parents of 150 pregnancies who declined pGS, including 33 individuals who underwent an invasive procedure. These parents were invited to participate in a semi-structured interview between 1 and 15 months post-partum. We used Thematic Analysis to code and analyze interviews.

Results: We interviewed 22 parents of 16 pregnancies. Reasons for declining testing included risks of invasive procedures (n = 19, 86%), lack of prenatally actionable findings (n …

A Double-Edged Sword: Ethical And Psychological Implications Of Apoe Genotype Disclosure Across The Lifespan, Diego Iacono

Department of Neurology Faculty Papers

The apolipoprotein E (APOE) gene is the strongest genetic risk factor for sporadic Alzheimer’s disease (AD), with the ε4 allele increasing risk and decreasing the average age of onset. While APOE genotyping is primarily used in research or clinical settings for patients with memory concerns, interest in disclosing APOE status to asymptomatic individuals—particularly during early adulthood—is growing. This trend is fueled by the rise of direct-to-consumer genetic testing and emerging prevention-focused clinical trials. However, ethical debates remain unresolved about the potential harms of early disclosure, including anxiety, stigma, and misunderstanding of probabilistic risk. Conversely, some argue that knowledge of APOE …

Spectrum Of Headache Disorders In Pakistan: A Multicenter Study, Amina Javed, Shafaq Saleem, Safia Awan, Saba Zaidi, Manzoor Lakhair, Fahad Saleem, Waleed Shahzad, Ahmed Wali

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective:

Headache disorders represent some of the most prevalent neurological conditions worldwide. While community-based

studies provide general prevalence, data on their diagnostic spectrum in specialized clinical settings in Pakistan remain

limited. The objective of this multicenter study was to evaluate the demographic distribution and spectrum of headache

disorders among patients presenting to neurological services across Pakistan.

Methods:

This cross-sectional observational study was carried out at 39 neurology centers across Pakistan, from August 2017

to December 2019. Diagnosis was made using International Classification of Headache Disorders, 3rd edition

(ICHD-3). Demographic details, and headache subtypes were compared across gender and …

Electrophysiological Localization And Prognostic Indicators In Radial Neuropathy Presenting As Wrist Drop: A Three-Year Retrospective Observational Study, Assad Ullah Khan, Muhammad Farooq, Saad Ali, Sadiq Ali Shah

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective:

Radial neuropathy is a common cause of wrist drop, and accurate lesion localization is essential for appropriate

management and prognostication. The objective of this study was to analyze electrophysiological localization patterns

of radial nerve lesions presenting as wrist drop and to assess whether earlier referral for electrophysiological evaluation

was associated with recovery outcomes.

Methods:

This retrospective observational study was conducted at Lady Reading Hospital Peshawar, a tertiary care setting, over

a three-year period (January 2022–December 2024). Adult patients with wrist drop and electrophysiological confirmed

radial neuropathy were included. Nerve conduction studies and needle electromyography were used to …

Visual And Brainstem Evoked Potentials: A Retrospective Cross-Sectional Audit From A Tertiary Care Hospital In Pakistan, Zuha Amin Alvi, Sundus Mehtab Shafee, Zahra Talib Shah, Dureshahwar Kanwar, Sajid Hameed

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective:

Visual and brainstem auditory evoked potentials (VEPs and BAEPs) are standard techniques for evaluating the integrity of visual and auditory pathways respectively. The objective of our audit study was to assess demographic trends,referral indications, and electrophysiological outcomes of patients undergoing VEP and BAEP testing in a tertiary care neurophysiology laboratory in Pakistan.

Methods:

A retrospective, cross-sectional audit was conducted of 952 patient records (VEP, n=219; BAEP, n=733) over a three-year period from neurophysiology laboratory of Aga Khan University Hospital. Demographic characteristics,clinical referral indications, and electrophysiological findings were collected. Standard ACNS guidelines were used for all recordings. Statistical …

Subacute Sclerosing Panencephalitis In A 24-Month-Old Child: A Rare Early Onset And Alarming Presentation, Arshad Mehmood, Javeria Raza Alvi, Sameen Qureshi, Ahmed Bilal, Shaila Ali, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Subacute sclerosing panencephalitis (SSPE) is a rare, progressive, and fatal neurodegenerative disorder caused by persistent measles virus infection. Early-onset SSPE in children under five years is uncommon but often rapidly progressive. We report a 24-month-old unvaccinated male who presented with progressive myoclonic seizures, gait difficulty, and rapid neurodevelopmental regression. Electroencephalography (EEG) showed periodic generalized discharges, and CSF measles antibody titers were elevated, fulfilling modified Dyken criteria. The child was classified as stage III SSPE. Symptomatic therapy including anti-seizure medications and supportive care, along with a planned ketogenic diet, was initiated but neurological outcome remained poor. This case emphasizes the aggressive …

Challenges Of Neurological Care In A Public Sector Hospital In Pakistan, Anila Umer

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Lack Of Multidisciplinary Collaboration In Stroke Rehabilitation In Pakistan: A Call For Integrated Care Models, Etisam Wahid, Shahzad Ahmad, Nimrah Humayoon

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Corrigendum: Correction Of Second Author’S Name And Affiliation In “Chorea As A Rare Manifestation Of Neuropsychiatric Systemic Lupus Erythematosus: A Case Report”, Editor Pjns

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Blood- Borne Biomarkers: Exploring The Frontiers Of Minimally-Invasive Diagnosis Of Alzheimer’S Disease, Sidra Afzal, Minahil Fatima, Nimra Afzal

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

From Molecules To Models: A Holistic Review Of Autism Spectrum Disorder Mechanisms And Research Tools, Sriya Gullapalli, Lois Baldado, Megan W. Szobody, Anesu K. Murambadoro, Kevin Garcia Valdez, Arjun Bellamkonda, Daniela Gonzalez, Usman Ghumman, Nikhilesh Anand, Kelsey A. Potter-Baker, Bharathi Gadad

School of Medicine Publications

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by persistent deficits in social communication and interaction, as well as restricted, repetitive patterns of behavior, interests, or activities. These features are associated with atypical early brain development and connectivity. While ASD has been traditionally associated with molecular genetic alterations, recent research highlights the significant contribution of various environmental factors to the pathophysiology of the disorder. Pathogenic genetic variations in key regulatory genes remain central to ASD risk; however, environmental influences such as advanced maternal or paternal age, poor maternal health during pregnancy, gestational diabetes mellitus, alterations in the early-life …

The Frontal Assessment Battery In Older Multilingual Kenyan Adults, Anne Njoki Gitere, Anne Nyambura, Karen Blackmon, Levi Muyela, Rachel Maina, Olivera Nesic Taylor,, Jasmit Shah, Dilraj Sokhi, Sylvia Mbugua, Samuel Gitau, Sheila Waa, Juzar Hooker, Zul Merali, Chinedu Momoh, Karen Blackmon

Brain and Mind Institute

Background: The Frontal Assessment Battery (FAB) was developed as a short (6-item) bedside assessment of executive dysfunction in older adults with suspected neurodegeneration. This study describes psychometric features of the FAB in multilingual Kenyan adults with and without clinical diagnosis of dementia.

Method: The FAB consists of six items assessing verbal abstract reasoning, lexical fluency, motor learning, and inhibitory control. The score on each item ranges from 0-3, with higher scores indicating better performance. Bilingual English-Swahili study personnel translated, blind back-translated, and applied consensus-driven cultural adaptations. FAB was then administered to 95 participants [71 cognitively unimpaired (CU) controls; 24 people …

Burden Of Neurodevelopmental Disorders In Kenyan Children, Symon Kariuki, Patricia Kipkemoi, Martha Kombe, Mary Bitta, Jacqueline Phillips Owen, Amina Abubakar, Charles Newton

Institute for Human Development, East Africa

Importance: Neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and intellectual disability contribute to one-tenth of the global burden of mental and neurologic disorders. The burden of NDDs is not well documented in Africa.

Objective:To assess the prevalence, risk factors, and comorbidities of NDDs in young Kenyan children.

Design, setting and participants: This cross-sectional study was conducted among children aged 6 to 9 years residing in the Kilifi Health and Demographic Surveillance System in Kenya. In stage I of the study, children were screened for NDDs from March 16, 2015, to September 14, 2016; those …

Neurology Residency Training In Pakistan: Current Status And Future, Bashir Soomro

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Alarming Rate Of Hemorrhagic Stroke Showing An Urgent Need For Hypertension Control: A Retrospective Study From A Major Stroke Center In Sindh, Sana Ghous, Muhammad Hashim Kalwar, Muhammad Hassan Butt, Irfan Ali Vighio, Mehfooz Ali Shah, Javed Khurshed Shaikh, Mansoor Hassan

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective:

Hemorrhagic stroke accounts for approximately 18–20% of the global stroke burden and is associated with high mortality and disability. It poses a significant challenge in low- and middle-income countries, where delayed presentation and inadequate risk factor control worsen outcomes. Hypertension remains the most important modifiable risk factor, particularly when poorly controlled. The objective of this study was to investigate the incidence of hemorrhagic stroke at a major stroke center and its association with uncontrolled hypertension.

Methods:

This retrospective study was conducted at Sindh institute of cardiovascular diseases (SICVD) Sukkur over three months, from May to July 2024. …

Living With Dementia In Kenya: Pathways To Care, Diagnosis And Management, Edna Bosire

Institute for Human Development, East Africa

Background: Sub-Saharan Africa (SSA) is experiencing a sharp rise in the size of theolder population; consequently, the incidence and prevalence of Alzheimer’s DiseaseRelated Dementias (AD/ADRD) is also expected to rise. There is limited research onAD/ADRD lived experiences have been conducted in SSA including Kenya. Our projectaimed to explore patient’s and caregivers lived experiences with Alzheimer’s disease inKenya.

Methods: This ethnographic study was conducted at the Aga Khan University hospital(AKUH), involving in-depth interviews with 21 health care providers, 26 patientswith mild cognitive impairment and 36 caregivers. We also conducted 10 homevisits and observations. Data were transcribed verbatim and thematically analysed.In what …

Blood-Based Clinical Markers For Early Dementia Detection: Insights From Ad-Detect-Cohort, Benard Aliwa, Jasmit Shah, Olivera Nesic Taylor,, Samuel Nguku, Juzar Hooker, Dilraj Sokhi, Sylvia Mbugua, Litha Musili, Rachel Maina, Harrison Kaleli, Levi Muyela, Anne Njoki Gitere, Anne Nyambura, Zul Merali, Karen Blackmon, Chinedu Momoh

Brain and Mind Institute

Background: Over 55 million people worldwide live with dementia, with more than60% residing in low- and middle-income countries. Alzheimer’s disease, the mostcommon form of dementia, accounts for 60–70% of cases. Early and accurate diagnosisremains a global challenge, necessitating novel approaches to mitigate the diseaseburden. Biomarkers hold significant promise in improving diagnostic accuracy andpredicting disease progression. Validated biomarkers for the preclinical stages ofdementia are crucial for advancing diagnosis and therapeutic strategies. We aimedto identify potential clinical markers for early dementia detection and assess theirpredictive accuracy in identifying high-risk individuals.

Method: We analyzed blood samples from dementia cases (n = 30) and …