Characteristics of a series of multiple sclerosis [MS] patients observed at the National MS Beta-Interferon Committee in Jordan over a one-year period [August 2009-August 2010]

To study the characteristics of multiple sclerosis [MS] in a series of Jordanian patients observed at the Beta-Interferon Committee and compare them with those from other Arab/Middle Eastern or Western countries. Data from 101 patients with MS attending the Jordanian National MS Beta-Interferon Committee over a one-year period, from August 1, 2009 to August 1, 2010, were collected. Mean age at MS onset was 27.1 years, with 70 females and 31 males [F/M ratio=2.26:l] with a peak incidence in the 3rd decade. Ten patients, all female, had early onset [below 18 years of age]. The mean disease duration was 3.3 years, with almost 1/2 of the patients having a short duration below one year. The most common clinical manifestation was limb weakness with pyramidal signs related to myelopathy followed by optic neuritis and brainstem symptoms. The most common MS pattern was relapsing-remitting [RR] in 66 patients with a relatively high number of clinically isolated syndromes [CIS] in 28 patients. There were 34 new cases in 2009 and 23 new cases over the study year [August 2009-August 2010], showing a trend toward an increase in incidence compared to previous years. All 101 patients were born and/or live in the center/North of Jordan and none in the South, with 69 patients in the capital Amman. Beta-Interferon was used in 81 patients. The general characteristics of MS in Jordan were similar to most Arab countries and Western reports. There is a possible north/south gradient of MS in Jordan and a trend toward an increase in incidence in recent years

Intracerebral hemorrhage

To study intracerebral hemorrhage [ICH] at Jordan University Hospital [JUH] with the aim of assessing prevalence, age/gender distribution, causes, clinical manifestations, and location of ICH on CT brain, treatment modalities and outcome, and to compare these findings with those from Middle Eastern and Western literature. Among 1498 patients with stroke seen over a 6-year-period, from January 2002 to December 2007 at JUH, Amman, Jordan, 100 patients with spontaneous ICH were studied retrospectively. The prevalence of ICH was 6.7%. The mean age was 61 years, with 71 males, and 29 females. The most common cause was hypertension, alone or combined with the use of aspirin and/or warfarin. The most common clinical manifestations were hemiparesis/plegia, impaired level of consciousness [mean Glasgow coma scale [GCS] score = 7.3] and headache/vomiting. The most common location on CT brain was in the basal ganglia [61 patients]. Seventy-nine patients received medical treatment and 21 had surgery. Forty-two patients died after a mean of 7 days [ranging from one day to 6 weeks]. The factors related to mortality were old age >68 years, GCS <8, intraventricular extension of ICH on CT brain and the presence of other comorbidities. Among 58 survivors, 50 were left with neurological deficit, predominantly hemiparesis/plegia in 46 patients. Twelve patients were left with chronic epilepsy. This study shows a lower prevalence of ICH compared to developed countries, a similar age and gender distribution, and hypertension as the major risk factor, which should be the focus of public health in Jordan and the Arab World

clinical and electrodiagnostic study of diabetic neuropathy at Jordan university hospital

To study diabetic neuropathy [DN] at Jordan University Hospital [JUH] with the aim of assessing age/gender distribution, risk factors, and other diabetic microvascular complications, clinical manifestations, results of nerve conduction studies [NCS], and treatment modalities, and to compare these findings with those from Western and other Middle/Far Eastern literatures. Among 562 patients with diabetes mellitus [DM] seen over a 2-year-period from January 2003 to January 2005, at the Diabetes center at Jordan University Hospital [JUH], 110 patients [10 DM type 1; 100 DM type 2] were studied retrospectively. The prevalence of DN was 20%. The mean age was 55.4 years [range 23-75], with 62 females and 48 males. The most common risk factors for DN were old age, long duration of DM, mean hemoglobin A1c, and hypertension. Almost 50% of patients had additional retinopathy, renal involvement, or both. The most common clinical symptoms were distal numbness/paresthesiae in the limbs [60% of patients] and the neurological examination was normal in 2/3 of patients [only 20% had stocking hypoesthesia to pain and temperature and absent ankle jerks]. The NCS showed an axonal neuropathy mainly affecting the lower limbs, especially sensory fibers [abnormal sural sensory action potential in 98% of patients]. Anticonvulsants [carbamazepine and gabapentin] were used efficiently in 50% of patients as symptomatic treatment, while tricyclic antidepressants were used as add-on in only 23 patients, due to anticholinergic side effects. In comparison with other studies, ours shows a lower prevalence of DN, similar age distribution with however, a predominance of females, similar risk factor profiles, clinical/NCS findings, and treatment modalities

Ulnar neuropathy at Jordan University Hospital

To study the causes, clinical and electromyography/nerve conduction study [EMG/NCS] findings and treatment modalities in Jordanian patients with ulnar neuropathy [UN] observed in a tertiary care referral center and compare the findings with those from Western literature. The case notes of 20 patients with UN referred to the neurophysiology department at Jordan University Hospital, Amman, Jordan, between January 2002 and January 2004 were reviewed. The clinical presentation, causes, EMG/NCS and treatment modalities were registered. Among the 20 patients, 18 were male and 2 female with a mean age of 39 years [range 14-68 years]. Ten cases were traumatic UN while the other 10 were presumably idiopathic cubital tunnel syndrome [CTS]. The most common clinical manifestations were paresthesiae of 4th/5th digits and weakness/atrophy of small hand muscles. All 10 cases of traumatic UN were axonal on EMG/NCS while among the other 10 with CTS, 3 diabetics had axonal injury and 6 out of 7 nondiabetics had a demyelinating injury, 3 sensorimotor and 3 pure sensory. Additional carpal tunnel syndrome was found in 5 patients. Needle EMG was abnormal only in cases of abnormal ulnar sensory action potential. Nine out of 10 with traumatic UN had surgery while only 3 out of 10 with CTS had cubital tunnel release. Compared to previous studies from Western literature, our study shows a similar male predominance as well as comparable clinical and neurophysiological findings and treatment modalities

Epilepsy at a University Hospital in Amman, Jordan

To study the clinical, EEG, neuroimaging, treatment results and outcome in Jordanian patients observed in a tertiary care referral center and compare the findings with those from Western and Middle/Far Eastern literature. The case notes of 200 patients with epilepsy examined in an adult neurology clinic at Jordan University Hospital, Amman, Jordan, between January 2000 and December 2002 were reviewed. The findings of the EEG records and CT or MRI of the brain were registered. Seizures were classified according to the International League Against Epilepsy into generalized and partial seizures. The results of the treatment with antiepileptic drugs [AEDs] as well as the outcome were assessed. Among the 200 patients reviewed, 119 were female and 81 were male, with a mean age of onset of 24.6 years, the majority [85%] were below 39 years. The main seizure types were generalized in 128 [64%] patients [92 patients with tonic clonic [TC] seizures] and partial in 72 patients. Interictal EEG was abnormal in 69% of the patients. Neuroimaging showed brain lesions in 33.5% of the patients with a higher yield in partial [56%] than in TC seizures [30%]. Sodium valproate and carbamazepine were the most frequently and efficiently used AEDs for generalized and partial seizures. After a 3 year follow-up, 76% were fully controlled with AEDs, outcome being better in generalized than partial seizures [worst in complex partial seizures]. Compared to the previous population on hospital based reports from Western and Middle/Far Eastern literature, our study showed a higher proportion of females and generalized seizures and a relatively better outcome with relatively similar early age of onset, yield of investigations and treatment modalities