Cerebral palsy in Saudi children

To describe the clinical profile, and identify its risk factors, of cerebral palsy [CP] as seen in a cohort of consecutive Saudi children aged between one and 3 years of age prospectively over a one-year period. Saudi children aged 1-3 years with CP [diagnosis based on specified criteria] were selected from children presenting to the Neurology service at the King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia with delayed milestones, seizures, mental retardation and difficulty with walking and evaluated at 3-monthly intervals for one year from January to December 2000. Information on gestation duration, labor and delivery, birth weight and the medical history of the mothers was obtained. Cranial computerized tomography and electroencephalography were carried out in addition to baseline investigations [toxoplasmosis, other, rubella, cytomegalovirus, and herpes simplex virus serology, serum lactate, pyruvate, amino acid screen, thyroid function tests, and chromosome analysis]. Somatosensory, molecular genetics and muscle biopsy for histopathologic and histochemical studies were not performed in any of the patients. One hundred and eighty-seven children with CP were seen during the study period: 109 males [mean age 20.3 +/- 8.69 months]; 78 females [mean age 20.6 +/- 8.55 months]. Seventy-three had microcephaly [<5th percentile] with a mean head circumference of 44.5 +/- 3.69 cms for males and 43.0 +/- 4.16 for females. The main symptoms were inability to walk independently [54%], delayed speech [52%] and seizures [45%]. The main neurologic features were motor weakness [85%], spasticity [60%], language dysfunction [42%], mental retardation [31%] and head lag [30%]. A history of previous CP in the family was obtained in 8 patients [4%] but none of them had other features of hereditary spastic paraplegia. Electroencephalography abnormalities, present in 113 [73%] were more frequent in those without seizures than with seizures. Cranial computerized tomography abnormalities were mainly cerebral atrophy [60%] and hydrocephalus [53.7%]. Twenty-five% were from twin pregnancies; 56 [34%] were of low birth weight, 20% were pre-term deliveries, birth asphyxia was present in 165 and breech presentation was encountered in 8%. The main risk factors identified were twin pregnancy, pre-term delivery, prolonged labor, low birth weight and a history of previous CP in the family. Our findings suggest that improved maternal and childcare particularly in the ante and perinatal periods may reduce the incidence of CP in this environment

Epilepsy in Saudi children with cerebral palsy

To study the clinical characteristics, electroencephalographic and computerized axial tomography profile in Saudi children with cerebral palsy who suffer epilepsy in a university referral center. A total of 113 patients with cerebral palsy and epilepsy was seen [67 boys, 46 girls] with an over all mean age 5.3 years [range.2-12 years] during the study period [January 1998 - December 1999]. They all had clinical evaluation and standardized electroencephalographic studies interpreted by the same examiner. The main clinical features were language delay [61%], hypotonia [45%], hypertonia [38%], and behavioral abnormalities [41%]. Seizure types included generalized in 96 [85%], and partial and complex partial with or without secondary generalization in 17 [15%]. None of the patients had simple partial seizures. The generalized seizures were non-convulsive in 4 patients [3.5%], tonic/clonic 73 [65%], atonic 3 [3%], myoclonic 16 [14%], and mixed 2 [2%]. Inter-ictal electroencephalographic abnormalities were epileptiform activity, generalized in 65 [57.5%] and focal 18 [16%], slow-wave activity in 58 [51%] and hypsarrythmia pattern in 6 [5%]. Only 9 patients had normal electroencephalogram. The cranial computerized tomography findings were normal in 11.5%. The main abnormalities were cerebral atrophy [65%], hydrocephalus [8%] and agenesis of the corpus callosum [8%]. The pattern of seizure type in patients with cerebral palsy and types of electroencephalogram abnormalities electroencephalogram and cranial computerized tomography are comparable to the results from studies in other clinical settings and environments

new anti-epileptic drugs: a clinical profile

Over the past few years, a number of new anti-epileptic drugs have been including: gabapentin, Iamotrigine, vigabatrin, topiramate, felbamate and tigabine. Several clinical studies showed efficacy of these anti-epileptic drugs on various types of seizures. However, the pharmacologic and clinical properties of these drugs remain to be fully defined. In this review, the pharmacokinetics, indications, and side-effects of the new anti-epileptic drugs are summarized

new anti-epileptic drugs: a clinical profile

Over the past few years, a number of new anti-epileptic drugs have been introduced including: gabapentin, lamotrigine, vigabatrin, topiramate, felbamate and tiagabine. Several clinical studies showed efficacy of these anti-epileptic drugs on various types of seizures. However, the pharmacologic and clinical properties of these drugs remain to be fully defined. In this review, the pharmacokinetics, indications, and side-effects of the new anti-epileptic drugs are summarized

Carpal tunnel syndrome: a clinical and electrophysiological study of 220 consecutive cases at King Fahd hospital of the university, Al-Khobar

To study the clinical and electrophysiological profile of patients with clinically diagnosed carpal tunnel syndrome [CTS] in the Eastern Province of Saudi Arabia. Neurology service at the King Fahd Hospital of the University [KFHU], Al-Khobar, Saudi Arabia. Two hundred and twenty consecutive patients [181 female, 39 male, mean age 37 and 44 years respectively], referred with a clinical diagnosis of CTS to the neurodiagnostic laboratories of KFHU between August 1991 and August 1995, formed the study group. They all had clinical evaluation and standardized nerve conduction studies [390 hands] performed by the same examiner. A control group of 64 normal subjects [31 females, 33 males, mean age 37 and 43 years respectively] were concurrently studied. Carpal tunnel syndrome was confirmed in 265 hands [68%]. The mean distal sensory peak latency [DSL] in milliseconds [ms +/- standard deviation [SD] was 4.61 +/- 1.54 ms [227 hands, 58.2%]. The mean distal motor latency [DML] was 5.87 +/- 1.5 ms [195 hands, 50%]. In 38 hands [9.7%] no sensory responses were recordable. Of these 4 hands [1%] had no motor responses as well. Seventy four percent of the patients were below 45 years of age. The main presenting symptoms were numbness [88.7%], pain in the hands [69.8%] and weakness [35.5%]. Sixty percent of the patients presented to hospital within one year of onset of symptoms. The frequency of associated conditions was highest for diabetes mellitus in 13.1% of the patients. The clinical and electrophysiological patterns of CTS in Saudi Arabia are similar to those reported from developed countries

Neurological disorders in institutionalized patients in the eastern province of Saudi Arabia

To define the spectrum and types of neurological disorders in patients residing in rehabilitation institutions in the eastern province of Saudi Arabia [Eastern Province, Kingdom of Saudi Arabia [KSA]]. Rehabilitation institutions in the Eastern Province, KSA. All the residents in the four rehabilitation institutions in the Eastern Province, KSA were evaluated by a neurologist and pediatrician. Six hundred and eight patients [352 males, 256 females] were seen: 244 [40.1%] were aged 13 years old or less; 321 [52.8%] were aged between 14 and 65 years and 43 [7.1%] were more than 65 years. The main neurological disorders seen were cerebral palsy and epilepsy in 531 [87.3%] and 172 [28.3%] cases respectively. Disorientation was encountered in 432 patients [79.4%] and behavioural problems in 255 [49.9%] in the form of hyperactivity [146 cases, 29%] and withdraw [109, 20.9%]. Receptive and expressive dysphasia were observed in 307 [55.4%] and 300 [49.3%] patients respectively with some degree of overlap. Other disabilities included hearing loss in 348 [57.2%] and visual impairment in 327 [53.8%]. Motor weakness was present in 306 patients [50.3%] in the form of quadriplegia [210], paraplegia [71], hemiplegia [15] and monoplegia [10]. Neurological abnormalities are common among residents of the four rehabilitation institutions in the study area. Identification and accurate quantitation of these and other abnormalities may prove useful in planning the type and scope of rehabilitation and other support services in such institutions

Electrophysiological findings in newly diagnosed non-insulin-dependent diabetics: a prospective study

This study reports the electrophysiological findings in patients with newly diagnosed non-insulin-dependent diabetes mellitus [NIDDM] studied in the Neurodiagnostic Laboratory of the King Fahd Hospital of the University [KFHU], Al-Khobar, Saudi Arabia. Twenty-nine patients [22 males, 7 females, mean ages 47 and 37 years, respectively] were studied within four weeks of establishing the diagnosis. They were all given nerve conduction studies by the same examiner. Comparison was made with data from a group of 64 normal control subjects. In the study patients, the mean distal sensory peak latency in milliseconds [ms] +/- standard deviation [SD] was 3.5 +/- 0.41 ms in 35 median nerves, 3.2 +/- 0.72 ms in 35 ulnar nerves, 1.9 +/- 0.34 ms in 23 superficial radial nerves and 3.5 +/- 0.61 in 36 sural nerves. The mean distal motor latency +/- SD was 4.6 +/- 0.95 ms in 39 median nerves, 3.5 +/- 0.58 ms in 38 ulnar nerves, 4.8 +/- 1.02 ms in 44 tibial nerves and 6.0 +/- 1.08 ms in 36 peroneal nerves. The electromyogram examination was performed on 24 patients and showed evidence of denervation and/or chronic reinnervation in seven [29%]. The frequency of abnormalities in the studied peripheral nerves was 60% for median, 63% ulnar, 33% peroneal, 16% tibial and 8% sural