Clinical and EEG characteristics of juvenile myoclonic epilepsy

To determine the clinical and electroencephalographic characteristics of patients with Juvenile Myoclonic Epilepsy [JME]. In this descriptive case series study, 60 patients of Juvenile myoclonic epilepsy [JME] were included. After detailed history clinical examination, Electroencephalography [EEG] with standard protocol was performed in all patients and was analyzed by a neurologist. Out of 60 patients, 26 [43.3%] were males and 34 [56.6%] were females. Mean age at the onset of myoclonic jerks [MJ] and generalized tonic clonic seizures [GTCS] was 13.7 +/- 2.12 years and 14.15 +/- 1.79 years respectively. Average delay in the diagnosis was 5.2 years. Myoclonic jerks [MJ] were present in all patients, GTCS in 52 [86.6%], and absence seizures in 8 [13.33%] patients. 6 [10%] had only Myoclonic Jerks. First seizure type was MJ in 52 [86.6%] and absence in 8 [13.3%]. Most common precipitating factors were sleep deprivation in 80% and fatigue in 66.6%. Family history for epilepsy was positive in 20%. Diagnosis by referring physicians was JME in only 6 [10%] patients. EEG was abnormal in 42 patients [70%] showing generalized, 4- to 6-Hz polyspike and wave in 27 [45%], generalized single spike/ sharp waves in 7 patients [11.6%], 8 [13.3%] patients had 3-Hz spike-and-wave [SW] activity in addition to the polyspike-and-wave [PSW] pattern. Independent focal EEG abnormalities were noted in 12 patients [20%]. Many of our patients were misdiagnosed by the referring physicians and were prescribed inappropriate antiepileptic drugs. Factors causing misdiagnosis were failure to elicit history of myoclonic jerks, misinterpreting myoclonic jerks as partial seizures and misinterpretation of EEG abnormalities

Stages of tuberculous meningitis: a clinicoradiologic analysis

To determine the frequencies and percentages of various clinicoradiologic variables of tuberculosis meningitis [TBM] with reference to British Medical Research Council [BMRC] staging of the disease. A case series. Department of Neurology, Jinnah Postgraduate Medical Centre, Karachi, from October 2010 to September 2011. The study included 93 adult patients with the diagnosis of tuberculous meningitis [TBM] at the study place. Patients were divided in three groups according to British Medical Research Council [BMRC] staging of TBM. Different clinical and radiological findings were analyzed at different stages of the disease. Data was analyzed using SPSS [Statistical Package of Social Sciences] version 11.0. A majority of patients were found to be in stage-II disease at the time of admission. History of illness at the time of admission was more than 2 weeks in 50% of stage-I patients but around 80% in stage-II and stage-III patients. Neck stiffness was the most commonly reported finding in all stages. Cranial nerve palsies were higher in stage-III [75%] than in stage-II [43%] and in stage-I [24%] patients. Hydrocephalus and basal enhancement was the most frequently reported radiographic abnormalities. Duration of illness and cranial nerve palsies are important variables in the diagnosis of TBM stages and if TBM is suspected, empiric treatment should be started immediately without bacteriologic proof to prevent morbidity and mortality

Etiologic patterns of ischaemic stroke in young adults

To determine the etiologic patterns of ischaemic stroke in young adults. A descriptive study. Department of Neurology, Jinnah Postgraduate Medical Centre, Karachi, from January to December 2010. All ischaemic stroke patients aged 15 - 45 years were included. The etiologic patterns were classified using TOAST [Trial of ORG 10172 in acute ischaemic stroke] classification and comparisons were made between different stroke subtypes with reference to traditional risk factors like age, smoking, hypertension, diabetes mellitus and dyslipidemia. Results were described in percentages. There were 75 cases and higher proportion of patients had ischaemic stroke due to cardiac etiology below the age of 35 years. Nineteen patients had cardioembolic stroke [8 [42.1%] males and 11 [57.9%] females]; 15 patients had large artery atherosclerosis [males 9 [60%], females 6 [40%]]; 17 patients had stroke of determined etiology [SDE], [6 [35.2%] males and 11 [64.8%] females] among whom 47% were due to venous sinus thrombosis. Twelve patients had stroke of undetermined etiology [SUE], [5 [41.6%] males and 7 [58.4%] females] and 12 patients had stroke due to small vessel disease [SVD] [8 males [66.7%] and 4 [33.3%] females. Cardioembolism, venous sinus thrombosis and premature atherosclerosis are common etiologies in young patients with acute ischaemic stroke

Pattern of analgesic overuse in probable medication overuse headache

This study aims to highlight the overuse of analgesics in patients with chronic daily headache who meet criteria for probable medication overuse headache. This was a cross-sectional comparative study conducted at the department of Neurology, JPMC, Karachi during a period of 1 year i.e. from 01-01-2011 to 31-12-2011. All patients with chronic daily headache were screened for probable Medication Overuse Headache. Total of 110 patients who met ICHD-II [international classification of headache disorder] criteria for probable Medication Overuse Headache [MOH] were included in this study. Detailed history and neurological examination were performed in all cases with appropriate blood workup, CSF studies and MRI+MRV in those cases where required. Drug history was taken in detail in all cases and pattern of overuse of different acute symptomatic medications was assessed with reference to underlying primary headache disorder. Total of 110 patients who met ICHD-II [revised] Criteria for probable MOH were included in this study. Females outnumbered males i.e. 2.3:1. This gender preference was noted in all primary headache subtype. Migraine was found more frequently[44.2%] in younger age groups with probable MOH while TTH [tension type headache] [55%] and other primary [83%] headache disorder [including Cluster Headache, New daily persistent headache] were more frequent disorders in old age patients with probable MOH. Among different analgesic medications, simple analgesics were found to be the most frequently overused acute symptomatic medication [66%] followed by combination analgesics [40.9%] and triptans /ergots [14.6%]. Use of combinations of various acute symptomatic medications was also assessed in patients with chronic primary headaches who met the criteria for probable MOH. Excessive use of acute symptomatic drugs without consultation with the treating physician should be discouraged. Patient education is very important about the genesis of the problem. Prophylactic treatment and follow up visits should be encouraged