Frequency of non-compliance of antiepileptic drugs among patients with epilepsy

Non-compliance with anti-epileptic drug treatment results in recurrent seizures and visits to the emergency departments of the hospitals has been identified as a social and economic problem. The aim of this study was to determine the prevalence of epileptic patients with non-compliance of anti-epileptic drugs and the understanding of patients living with epilepsy who presented to the emergency department with seizures. A descriptive study design was employed and the data-collection tools were a questionnaire for this study. The average age of the study population was 46 years. There was 60% males and 40% females in this study. Non-compliance of anti-epileptic drugs was found to be in 53 patients out of a total of 225 resulting in the frequency of 23%. Stratification of patients with non-compliance showed that incidence of non-compliance was more frequent in males since frequency in males was 63% and in females frequency of non-compliance was only 37%. So major causes of non-compliance should be adressed both in males and females to manage this diseases in the region

Neurology training in Pakistan: 2020-2025

As the year 2019 comes to end, many advances in neurology has been occurred over worldwide and is still going on. The emergence of new devices and drugs will help neurologists with additional therapeutic options to optimize the patient care especially in more complex cases. Antibody therapies especially monoclonal antibodies are flooding the landscape in nearly every discipline of neurology is no exception. We watched newer clinical trials, gain FDA approval for use, and many more therapeutic evidence-based interventions enter the pipeline. Neurology in the 20th century has undergone extraordinary changes, particularly in the past few decades. We trace the major trends, including the growth of the field, the technological advances, and the revolution in neuroscience, the emergence of neurology as a free-standing specialty, the rise of child neurology, and the development of neurological subspecialisation in stroke and neurovascular intervention

Longitudinally Extensive Transverse Myelitis and Neuromyelitis Optica spectrum Disorder: A Tertiary Care Centre Experience

ABSTRACT OBJECTIVE: To determine the frequency of longitudinally extensive transverse myelitis and Causes of longitudinally extensive transverse myelitis METHODOLOGY: A Cross-Sectional, retrospective study was conducted at Neurology Department, Mayo Hospital, Lahore from 1st January 2015 to 31st December 2015. Patients were included from inpatient with history of weakness of lower limbs/all four limbs with or without visual disturbances. History and clinical examination was consistent with transverse myelitis. Neuroimaging (MRI brain, (orbit in case of optic neuritis) and spinal cord) was done followed by LP/CSF, Vasculitis screening

Clinical Spectrum, Risk Factors and Electrophysiologic Aspect of Radial Nerve Injury

ABSTRACT Background and objective: Radial nerve is injured due to a variety of reasons. The objective of this study was to determine the clinical spectrum, risk factors and electrophysiologic aspect of radial nerve injury presenting to a tertiary care hospital in Lahore. Methods: This descriptive prospective cross-sectional study was conducted at department of Neurology, Mayo hospital Lahore from July 2022 to December 2022 and comprised patients with isolated radial nerve injury on the basis of history and clinical examination regardless of their gender, above 15 years of age. NCS/EMG was done on a Japanese machine Nihon Kohden by an expert as per recommended protocol for electrodiagnostic evaluation of a suspected radial nerve injury and interpreted by consultant neurologist. Results: Of 75 patients, 52(69.3%) were males and 23(30.7%) were females. The most common etiology turned out to be misplaced intramuscular injection in 45(60%) of the patients. The site of lesion in most cases was in the spiral groove in 36 (40%) of the patient. Most of the patients i.e. 71(94.7%) had a wrist drop. Evidence of reinnervation was present in 30(40%) of patients. Conclusion: Most cases of radial nerve injury presented with a wrist drop in which the commonest etiology was misplaced intramuscular injection. The site of lesion in most cases turned out to at the level of spiral groove, and the nature of lesion was primarily axonal loss followed by secondary demyelination

Frequency of depression in patients with stroke

Stroke is a common neurological problem and the third leading cause of death in developed countries of the world. Among survivors, over 50% develop significant disabilities including neuro-psychiatric disabilities. Post stroke depression (PSD) is a common but less reported condition among survivors. Objectives: To determine the frequency of depression in patients with stroke. Materials and methods: This was a cross-sectional study conducted at Department of Neurology, Services Hospital, Lahore from January, 2014 to December, 2014 over a period of 1 year. A total of 100 cases having stroke minimum 1 month ago, were recruited in the study. For evidence of depression, Personal Health Questionnaire (PHQ-9) with criteria for mild, moderate, moderately sever and severe depression was used. Results: Mean age of the patients was 54.8 ± 8.1 years. In our study 63% of the patients were female while 37% patients were male. Post stroke depression was found in 35% of cases; 15% had severe depression, 8% had moderately severe, 9 % had moderate and only 3% patients had mild depression. Among these 35 patients, 22 patients (62.8%)had involvement of dominant half of brain while 13 patients (37.2%) had non-dominant half involved. Conclusion: Post stroke depression is present in significant number of post stroke patients. So it is advised to do PSD evaluation of all stroke patients for early and proper management

Clinical Outcome of Cortical Venous Thrombosis in Stroke Patients at a Tertiary Care Hospital of Southern Punjab

Objective:  This study was determined to find out the clinical Outcome of Cortical Venous Thrombosis (CVT) in Stroke patients at a Tertiary Care Hospital of Southern Punjab. Material & Methods:  A total of 100 patients with cortical venous thrombosis were included in this descriptive case series study, which was conducted at Department of Neurology, Nishtar Hospital Multan. Outcome of patients in terms of partial recovery or complete recovery, any recurrence, any complication, indication for Surgery and any disability in terms of focal deficit, prolonged hospital stay and Mortality was followed. Results:  Our study included a total of 100 patients with cortical venous thrombosis (CVT), 35 (35%) were male and 65 (65%) were female patients with their mean age was 37.69 ± 16.52 years, ranging from 20 – 83 years (51.37 ± 17.44 in males versus 30.32 ± 10.15 years for females). Headache was noted in 80%, focal deficit in 57%, nerve palsy in 30%, coma in 22% and disability was noted in 35%. Partial recovery was noted in 65%, whereas complete recovery was noted in 35% while, complications were noted in 12 (12%) of these patients with CVT. Conclusion:  Cortical venous thrombosis was more prevalent in females in their younger age groups and it was associated with poor prognosis as high frequency of partial recovery was noted in our study. Keywords:  Cortical venous thrombosis, Stroke, headache, recovery, outcome

Hematological Profile of Patients with Dementia in South Punjab

Objectives:  A case-control study was conducted to find the prevalence of abnormal blood indices and electrolytes in patients with dementia. Material & Methods:  The levels of erythrocytes, leukocytes, platelets, electrolytes, and ESR were determined from the biochemistry lab. A t-test was applied to see the significance of the difference between each dementia patient group (Alzheimer Disease-AD, Parkinson’s Disease-PD, and Frontotemporal Dementia-FTD) with the control group for each CBC and electrolyte parameter Results:  In each patients’ groups (AD, PD, and FTD), the mean value of every erythrocyte was lower than the normal range. A significant difference existed for each erythrocyte between dementia patients and controls, except MCHC. Low levels were observed in neutrophils in all groups of dementia including control group. Very high levels were observed in ESR in all groups of dementia. Significant differences existed in the WBC levels between controls and AD as well as PD patients, in platelets between the control group and FTD patients, and in ESR in each group of dementia patients vs. control group. Normal values observed in all groups of dementia patients as well as in the control group.  Conclusion:  We found low levels in erythrocytes in cases of Alzheimer disease, Parkinson’s disease, and frontotemporal dementia. Age-related changes to hematological indices especially related to RBCs, and inflammatory mediators like cytokines, hamper the microcirculation in the cerebral tissue leading to micro-infarcts or microbleeds which cause neuronal insults and parenchymal damage

Spectrum of Fugitive Diagnosis of Neurological Disorders in Elderly

ABSTRACT BACKGROUND Fugitive diagnosis “escape from true diagnosis” of neurological disorders is very common in elderly patients. It’s not always an underlying disease symptom or progression in old age. Aim of this study is to determine the frequency and nature of fugitive diagnosis of neurodegenerative brain disorders in old age. MATERIAL AND METHODS STUDY DESIGN A study was conducted in private Neuro-clinic in Lahore. Study duration is 3 years from to 1st January, 2017 to 31th December, 2019. It was a prospective, cross sectional study. Inclusion criteria: 1) Age \u3e60years 2) Neurodegenerative brain disorders including vascular dementia 3) with or without associated co morbidities e.g., DM, HTN, IHD. Exclusion criteria: age \u3c60, all acquired other neurological disorder RESULTS Total number of patients (n=2570) visited to Neuro-clinic with various neurological disorders.950 patients had neurodegenerative diseases. A total of 241 patients(n=241) with neurodegenerative diseases like Parkinson’s disease, Alzheimer’s disease, Lewy body disease vascular dementia and fronto-temporal dementia having fugitive diagnosis during their course of treatment were included in the study. Study sample consisted of 134 males and 107 female patients. The patients included in study were aged equal to or more than 60 years. True diagnosis was as follows; refusal to take oral medications or keeping food in mouth 73/241, (30.29%), misdiagnosed as advanced dementia or early Alzheimer’s disease, Serotonin Syndrome 23/241, (09.54%), Subacute Encephalopathy 67/241, (27.80%) caused by infections e.g. urinary tract infection or pneumonia, hyponatremia, were taken as advanced widespread disease or deepening encephalopathy due to metabolic cause, Depression in 47/241, (19.50%), was taken as worsening of symptoms or polypharmacy. Impulse control disorders 31/241, (12.86%) were misdiagnosed as extremes of behavior with efforts leading to hospitalization in psychiatric institution. CONCLUSION Fugitive diagnosis in patients with neurologic symptoms and signs, especially in neurodegenerative disorders results in worsening of patient condition with no chance of benefit. The patient is subjected to inappropriate, ineffective and potentially harmful treatment. Fugitive diagnosis fails to address symptoms, delays appropriate therapy, and may lead to worst prognosis. Finally, it may lead to unnecessary higher cost of treatment for patient in particular and health care system in general. So clinical guidelines should be made to overcome these situations

Normal Pressure Hydrocephalus; Outcome after Ventriculoperitoneal Shunt

Background: Normal pressure hydrocephalus (NPH) is a treatable cause of dementia. Hakim and Adams des-cribed for the first time the symptoms and signs of NPH which include ataxia, progressive memory loss and uri-nary incontinence. In properly diagnosed cases, ventriculoperitoneal (VP) shunt leads to good outcome.Material and Methods: This study comprised of 40 patients with NPH. The duration of study was 5 years from January 2009 to December 2013. The duration of illness before presentation ranged from one year to 6 years. The patients were diagnosed clinically and CT scan brain was done in all patients (MRI in some patients). All patients underwent Folstein Mini-Mental State Examination. In cases of possible NPH, drainage lumbar puncture (LP) was done and their response was noted. In 35 patients whose families gave consent for surgery, VP shunt was done while families of 5 patients refused surgery. The patients who underwent VP shunt were followed up, which ranged from one to 5 years.Results: The age of the patients was between 52 and 70 years. The majority of patients (25) were between 61-70 years. Out of the 35 patients, 26 (75%) were male while 9 (25%) were female. The initial symptom in all these patients was gait ataxia and the duration of illness ranged from one year to 6 years.Conclusion: Normal pressure hydrocephalus (NPH) is a treatable cause of dementia. In properly diagnosed pat-ients, ventriculoperitoneal shunt gives good results