Evaluation of intractable epilepsy. Invasive monitoring

Accurate localization of the epileptogenic zone is the fundamental key factor for successful epilepsy surgery. Despite the progress achieved in the field of neuroimaging, invasive intracranial recording is still the gold standard that helps recognize the patient population who may profit from surgery. Meticulous implantation of intracranial electrodes and judicious interpretation of their data is a definite need in a successful epilepsy program. Few centers in the Arab world are involved in that domain. Moreover, the society itself is not well informed to appreciate the potentials of surgical treatment of seizure disorders. In the review article, we will go over various types of intracranial recordings, discussing their indications, and the last updates for each. Some of the cases carried out at the American University of Beirut Medical Center, Beirut, Lebanon will be illustrated as examples of our current practice. Then, the future of epilepsy monitoring will be highlighted in brief

Intracranial hydatid cyst. Dilemma in diagnosis and management

Intracranial hydatid disease is a parasitic infection that affects children in endemic areas such as the Mediterranean, South America, and Australia. In non-endemic areas, it is rare and may pose a diagnostic dilemma. We review a boy who presented with a right cerebral cyst. All investigations were negative, and hydatid cyst was encountered upon intra-operative exploration. We review the available diagnostic modalities, and the difficulty in reaching a preoperative diagnosis. We also review the surgical and medical treatment strategies. A cerebral hydatid cyst should be considered in children with cystic brain lesions even in non-endemic areas. Since serologic tests are frequently negative, the most reliable methods in reaching a diagnosis are radiological evaluation and histopathological examination. The cyst has a typical appearance on CT and MRI and this bears special importance on the treatment strategy where the cyst is best removed intact to avoid recurrence or anaphylaxis

Prevalence of neuropathic pain among patients suffering from chronic low back pain in Saudi Arabia

The aim of this study was to assess the prevalence of neuropathic pain among patients suffering from chronic low back pain using the Leeds assessment of neuropathic symptoms and signs [LANSS] pain scale. This was a pilot study collected from 10 centers in the Middle East Region, with each center enrolling 10 patients between November 2004 and January 2004. In total, 100 patients with chronic low back pain were included in the study. The LANSS clinical assessment score was used to assess the presence of neuropathic pain. Patients with score >/= 12 were considered to have neuropathic pain, while patients with score a less than 12 were considered as having nociceptive pain. We found that 41% of the chronic low back pain patients had neuropathic pain and 59% had nociceptive pain. The ability to identify neuropathic pain mechanisms should lead to individualized treatment resulting in improved pain control in this group of patients with chronic low back pain