Local experience of management of infantile spasms and its treatment: a retrospective study of ten cases

To evaluate and assess the efficacy of ACTH and Vigabatrin in Symptomatic variety of Infantile Spasm in Pakistani patients to document local experience. This is a retrospective study carried out at Neuro Diagnostic Centre, Hamdard University Hospital [Taj Medical Complex], Karachi, from January 2006 to December 2008. Patients registered with Infantile Spasm to the Neuro Diagnostic Centre, Karachi, Pakistan between January 2006 to December 2008 were included in the study. The total number of patients was ten; six male and four female. Age ranged from four months to three and a half years. All patients demonstrated electroencephalographic evidence of hypsarrhythmia and a variety of jerks representing Infantile Spasm. ACTH was administered in nine out of ten patients but always in combination. Six out of ten patients had Vigabatrin used in tandem with ACTH initially and later Vigabatrin alone [was continued in five of these patients]. In one patient Vigabatrin was continued with ACTH and Valproate. ACTH was combined with Valproate in three of the patients while Valproate alone was tried in one patient. All patients on ACTH in whatever combination responded adequately and some of them dramatically becoming seizure-free. The patient on Valproate alone did not respond early and took almost 20 days from start of treatment to become seizure-free. ACTH was highly effective especially in patients with symptomatic form of Infantile Spasm. Although prednisolone [oral] has not been tried in this study but in affording patients ACTH should remain the first-line treatment for Infantile Spasm especially the symptomatic variety

Multicentre based study on stratification of modifiable risk factors in stroke

To study the frequency of modifiable risk factors in ischaemic and haemorrhagic strokes. It is a prospective descriptive multicentre based study conducted in the neurology ward of Civil Hospital and Neuro Diagnostic Centre, Karachi from July 2007 to February 2008. A questionnaire was prepared in accordance with the objective of the study. It contained detailed history, neurological examination and investigations. Every patient enrolled in the study underwent either a CT Scan, an MRI or an MRA to establish the diagnosis of a stroke and establishing the cause of the stroke whether it was ischaemic or haemorrhagic. Risk factors for these patients and their age of onset was also studied. Fifty patients with established diagnosis of stroke were selected; forty-three suffered from ischaemic stroke [86%] while seven fell into the category of haemorrhagic stroke [14%]. Thirty-two [64%] patients had more than one risk factor. The age range of patients was from 17 to 80 years. Out of 50 patients twenty-nine [58%] were males and twenty-one [42%] were females. The commonest risk factor of ischemic stroke was hypertension [32.61%] followed by diabetes [23.91%], hyperlipidaemia [23.91%] and ischaemic heart disease [19.57%] where as in haemorrhagic stroke it was also high blood pressure [71.4%] and aneurysm [28.57%]. Majority of the patients studied had one or more modifiable risk factors. The commonest risk factor was hypertension 32.61% followed by diabetes 23.91%