A. D'souza

Newly diagnosed multiple sclerosis in state of Qatar.

BACKGROUND Epidemiologic studies on multiple sclerosis (MS) are well-documented in the western population but to a lesser extent in Arab world. OBJECTIVE To study the demographics, clinical aspects, radiologic and laboratory features along with the degree of disability inflicted, and factors affecting disease progression and outcome of newly diagnosed MS patients at our institution. METHODS Data from all newly diagnosed MS patients fulfilling McDonald criteria from January 01, 2005 to December 31, 2010 were collected and analyzed. RESULTS A total of 142 patients were identified, in which 82 (58%) were Qataris, and 90 (64%) females. Mean age was 31 years, and mean duration of symptoms was 24 days (median 15 days). Most common symptoms were sensory (63%), followed by visual (45%) and motor (43%). Mean EDSS was 2.3 at presentation. Treatment was given to 127 (89%), and relapse observed in 49%. Gadolinium enhancing lesions on follow-up MRI brain and relapsing remitting MS were associated with increased radiologic disease burden, while weakness at onset, EDSS of ≥2.5 and ≥3 clinical relapse was associated with clinical disease progression. CONCLUSION MS in Qatar is an emerging disorder especially in the native population. The pattern of disease differs from other Middle Eastern countries by its milder clinical and aggressive radiologic disease presentation.

Neurocysticercosis presenting as a vertical one-and-a-half syndrome with associated contralesional horizontal gaze paresis.

We describe a patient presenting with vertical one-and-a-half syndrome and concomitant contralesional horizontal gaze paresis as the result of a solitary neurocysticercosis (NCC) lesion in the right midbrain extending into the thalamomesencephalic junction. The patient received an albendazole-dexamethasone course which resulted in resolution of his symptoms. The neuro-ophthalmological complications of NCC are reviewed and the clinical topography of the neuro-ophthalmological findings of this unusual observation are discussed.

Slow pseudoperiodic lateralized epileptiform discharges in nonconvulsive status epilepticus in a patient with cerebral palsy and a large central meningioma

The presence of cerebral palsy and that of slow growing brain tumors are risk factors for convulsive and nonconvulsive status epilepticus. Nonconvulsive status epilepticus (NCSE) needs electroencephalographic (EEG) monitoring to be confirmed as it may be clinically subtle. Furthermore, it may present with a variety of ictal EEG morphologies. We report a case of a patient with cerebral palsy and a large central meningioma. Electroencephalogram showed a slow pattern of periodic lateralized epileptiform discharges (PLEDs) (a pattern considered as being situated in the ictal–interictal continuum) on an alpha background. The patient was treated for NCSE successfully with benzodiazepines followed by up-titration of his antiepileptic drug doses.

Sustained‐release valproate in partial epilepsy: comparison between VIPe and Gulf VIPe study findings

We read with interest the paper of Jędrzejczak et al., on the effectiveness and tolerability of sustained-release valproate (Depakine Chrono ) as first-line antiepileptic drug (AED) in newly diagnosed partial focal epilepsy (VIPe study) [1]. In fact, recently we published the results of a study with an identical protocol but performed in the Arabian Gulf countries (Bahrain, Kuwait, Oman, Qatar, United Arab Emirates) (Gulf VIPe study) [2]. The VIPe study represented a very heterogeneous population including countries from Eastern Europe, East Asia, South East Asia, North and South Africa. Admittedly, the number of patients in these two studies was different (intentionto-treat population in the Gulf VIPe study was 77 vs. 1 192 in the VIPe study). A few remarkable dissimilarities between the two study populations can be found. Although the age was comparable in both study populations, the weight in the Gulf VIPe study population was 46% and 11% higher in the children and adults, respectively, compared with the VIPe population. Despite this, the median daily valproate dose in the child group was 19% lower in the Gulf VIPe population, while the dose for the adult group in both studies was similar. The Gulf VIPe adults were diagnosed with epilepsy much earlier than those in the VIPe study (17 years vs. 10 years). Remarkably, although the type of seizures and etiology was comparable in both studies, the primary outcome parameter (remission rate at 6 months) was 10% higher for each of the age categories in the Gulf VIPe compared with the VIPe population, indicating that the drug was more effective in the Gulf VIPe study population. In addition the response rate was also faster in the Gulf VIPe study population, with 82% of the patients being seizure free after 2 months, corresponding to a 20% higher response rate compared with the VIPe population. The safety profile of sustained-release valproate (Depakine Chrono ) was comparable in both study populations (18% in the VIPe and 20% in the Gulf VIPe study), except for weight gain which was less prominent in the Gulf VIPe study population. It is likely that genetic differences between both study populations accounted for the differences in pharmacodynamic response observed. This should prompt the pharmaceutical industry to include the Arabian Gulf region with its rapidly growing population in future clinical drug development.

Ataxia hemiparética en un infarto lacunar lentículo-capsular con evolución favorable: Algunas consideraciones fisiopatológicas

Hemi paretic ataxia (HA) is a lacunars syndrome that presents with motor deficit and pyramidalism associated to ipsilateral ataxia out of proportion to such deficit. Topography of lesions is wide and acute infarcts have been recognized at the infernal capsule, pons, thalamus, corona radiate and cortex. Symptoms are associated to involvement of pyramidal and corticopontocerebellar tracts. We report a 44-year-old mole presenting with right hemi paresis and severe ataxia. The magnetic resonance imaging showed a sub acute infarction of the left lenticular nucleus and infernal capsule. The patient was treated with physiotherapy, anti platelet agents and statins and was discharged with an evident recovery.