Health related quality of life in a Saudi population of patients with epilepsy.

OBJECTIVES: To assess the quality of life for epilepsy patients in Saudi Arabia. Epilepsy, one of the most prevalent chronic neurological conditions in the world, frequently results in a low quality of life. METHODS: This cross-sectional study analyzed data between September 2020 and September 2021 from 102 adult patients with epilepsy in outpatient clinics department of Epilepsy Program at King Fahad Medical City compared it to 108 healthy controls during the same study period. Sociodemographics and clinical data were gathered using the Arabic version of the Rand 36-Item Short Form Survey (SF-36) questionnaire and the Quality of Life in Epilepsy Inventory (QOLIE-31). RESULTS: Patients with epilepsy had lower SF-36 scores when compared to the control for role limitation due to physical health, role limitations due to emotional health, and general health. The QOLIE-31 revealed that gender was associated with energy/fatigue (p=0.028), medication effect (p=0.016), and social function (p=0.003); only social functioning showed a significant association (p=0.023) with employment. CONCLUSION: Quality of life for patients with epilepsy was found to be significantly impacted in Saudi Arabia. Certain factors found in this study differentiate it from data that has already been released. This might be due to Arab differences in family support as well as cultural and religious beliefs.

Adherence of Saudi women with epilepsy to folic acid intake in the preconceptional period in two tertiary care hospitals in Riyadh: A cross sectional study.

Antiseizure medication have been associated with an increasing risk of congenital anomalies. Medical authorities recommend taking folic acid during the pre-conceptional period to reduce the risk of congenital malformations in the newborns of women with epilepsy (WWE). In this cross-sectional study, we aimed to measure the adherence of Saudi WWE to folic acid intake. We included WWE visiting outpatient epilepsy clinics in King Abdulaziz Medical City and King Fahad Medical City in Riyadh between September 2017 and August 2018. By consecutive non-probability sampling, we identified 85 patients who met the inclusion criteria of the study. The data were collected by a self-administrated questionnaire. We found that the mean age of the subjects was 33 ± 7.5 years. One third were university graduates. Eighty percent were aware of the role of folic acid in preventing congenital anomalies, and 63.9% were taking it during the preconceptional period. No association was found between educational level and adherence to folic acid intake. In conclusion, adherence to folic acid intake among Saudi WWE is not optimal. More efforts are needed to increase patient adherence to folic acid intake.

Automatic Detection of Epileptiform EEG Discharges based on the Semi-Classical Signal Analysis (SCSA) method.

In this paper we utilize a signal processing tool, which can help physicians and clinical researchers to automate the process of EEG epileptiform spike detection. The semi-classical signal analysis method (SCSA) is a data-driven signal decomposition method developed for pulse-shaped signal characterization. We present an algorithm framework to process and extract features from the patient's EEG recording by deriving the mathematical motivation behind SCSA and quantifying existing spike diagnosis criterion with it. The proposed method can help reduce the amount of data to manually analyse. We have tested our proposed algorithm framework with real data, which guarantees the method's statistical reliability and robustness.

Severe ataxia uncovered Hodgkin's lymphoma: do not forget CT neck when looking for covert malignancy.

A 53-year-old woman without medical problems presented with 5-month history of dizziness, difficulty speaking, severe ataxia, which worsened a day before admission to inability to stand unsupported. An extensive workup was initiated to find the cause of ataxia. The laboratory investigations and imaging of the brain and whole spine revealed no lesions. She was found to have autoimmune thyroiditis, positive coeliac disease antibodies without clinical features and vitamin D deficiency. No intravenous steroids or immunosuppressive therapy was given. Cerebrospinal fluid showed lymphocytic pleocytosis. The workup for the cause of severe ataxia revealed an oropharyngeal lesion with cervical lymph nodes, and the biopsy showed classical Hodgkin's lymphoma of mixed cellularity. She was treated with chemotherapy followed by radiation therapy and made a remarkable recovery, and currently, she is in remission without distant metastases, 5 years after the initial diagnosis. Her neurological status improved, and she remained with mild ataxia.

Chronic inflammatory demyelinating polyneuropathy evolving to primary CNS lymphoma.

A 56-year-old woman presented with 3 months history of all four limbs' numbness in glove and stocking distribution. A week before admission, she developed all four limbs' weakness and numbness. Brain and whole spine imaging revealed no lesions, and cerebrospinal fluid showed high protein. A nerve conduction study revealed severe sensorimotor polyneuropathy, and she was diagnosed with chronic inflammatory demyelinating polyneuropathy. We treated her with plasma exchange and later developed bilateral pulmonary embolism, deep venous thrombosis and worsening of weakness. The second set of seven sessions of plasma exchange gave her improvement in muscle strength. However, after a chest infection, another neurological deterioration occurred. The third set of plasma exchanges resulted in excellent response. Nineteen months into her illness she developed a headache followed by left upper limb weakness and focal seizures with left side involvement. Brain imaging revealed a right frontal enhancing lesion that required resection, and biopsy showed diffuse large B-cell lymphoma. She was treated with chemotherapy and whole-brain radiation therapy and remained with left-sided weakness.

Focal Cortical Dysplasia and Generalized Epileptiform Discharges: Case Report and Literature Review.

BACKGROUND: Focal epilepsy can have a varied etiology, including malformations of cortical development (MCD), that can often be detected by Magnetic Resonance Imaging (MRI).Here we show a distinct characteristic of two forms of MCDs on MRI, with two tight dipole clusters in her MEG magnetoencephalography study, in a patient with electroencephalography (EEG) features of generalized epilepsy. CASE REPORT: This is a case presentation of a 20 years old female with epilepsy, found to have upon EMU admission two pathologies (FCD, heterotropia) over the right side near the collateral sulcus, and two tight clusters of dipoles over the right parietal and left temporo-parietal region, with generalized inter ictal discharges in her EEG. FCD is a common etiology of medically intractable seizures and usually in EEG it will show either: pseudo-periodic spikes or rhythmic spikes, poly-spike or repetitive electrographic seizures or a brief discharge of fast rhythmic activity, atypical presentation with generalized epileptiform discharges were rarely reported. CONCLUSION: The presence of MCD does not preclude a patient from having other types of epilepsy. Generalized epilepsy and focal related epilepsy have a distinct pathophysiology.

Multiple cranial neuropathies in cerebral venous sinus thrombosis.

Clinical presentation of cerebral venous sinus thrombosis (CVST) is varied and often mimics many neurological disorders, making it a diagnostic challenge, and cranial nerve palsy in CVST is rare and its pathophysiology remains unclear. We report a case of a 19-year-old male with a history of whiplash injury, admitted with extensive CVST, developed right facial nerve palsy with extension of thrombus into the ipsilateral transverse sinus, sigmoid sinus and internal jugular vein. Later, he developed left facial nerve palsy with partial left occulomotor weakness. We suggest that either reversible compromised oxygen or glucose consumption within the intrinsic vascular system of the nerve, resulting in cranial nerve abnormalities. CVST should be considered in cases of trivial trauma, even in the absence of hyper-coagulable states, and it can have atypical presentation like multiple cranial neuropathies.