Community survey of neurological disorders in Saudi Arabia: Results of the pilot study in Agrabiah

Caregiver Knowledge, Attitude, and Behavior toward Care of Children with Cerebral Palsy: A Saudi Arabian Perspective

The care of children with cerebral palsy (CP) requires a complex system of care that is not only dependent on health care resources, but is also strongly influenced by social and cultural attributes. Hence, it is important to explore the understanding and practices of caregivers within a regional perspective. This study was conducted to investigate the knowledge, attitude, and behavior (KAB) of parents with children diagnosed with CP in Saudi Arabia. A cross sectional survey was conducted on the caregivers of children with CP admitted for inpatient rehabilitation between October 2023 to January 2024. A total of 216 caregivers participated in this survey. About 82.9% of caregivers were the mothers of CP children, half (50.5%) were ≤36 years old, 53.7% were highly educated, and 89.2% lived in urban areas. More than half of the participants (57.7%) owned their homes. Regarding children, spastic quadriplegia was the most common type (46.3% of cases). Overall, the participants recorded good values for all variables for KAB. The mean value for attitude was higher (2.67 ± 0.20) when compared to behavior (2.49 ± 0.36) and knowledge (2.46 ± 0.25). Participants who had children with spastic quadriplegia CP reported lower behavior scores than their peers. Strategies with a special emphasis on improving the behaviors of caregivers for children with quadriplegia need to be adapted. Similarly, the living situations of families need to be taken into consideration given its significant association with the attitude of caregivers. A considerable lack of knowledge in handling emergency situations by caregivers signifies a gap in care, which could have potentially life-threatening consequences.

Saudi Cerebral Palsy Register (SCPR): Protocol on the Methods and Technical Details

This protocol presents a comprehensive proposal for the establishment of the Saudi Cerebral Palsy Register (SCPR), a crucial project for investigating and addressing the prevalence, etiology, and management of cerebral palsy (CP) in Saudi Arabia. The SCPR will not only provide a robust database for ongoing research and analysis but will also serve as a platform for investigating the causes of CP, implementing preventative strategies, and improving the quality of care and outcomes for people with CP and their families in Saudi Arabia. Detailed case definitions, inclusion/exclusion criteria, and data collection protocols are discussed to ensure the integrity and comparability of the data. The plan also outlines strategic funding, institutional and government endorsement, sustainability considerations, potential challenges and proposed solutions, and expected outcomes and impact. These include creating research and educational opportunities, fostering regional and international collaborations, and significantly contributing to CP prevention strategies. Overcoming anticipated obstacles, such as stigma, institutional policies, and collaborations, and securing both necessary funding and endorsements are highlighted as critical for the success of the SCPR. The project is not only aligned with promote prevention of health risks, a target of Vision 2030 in Saudi Arabia, but is also expected to have a substantial impact on the health and quality of life of people with CP and their families in Saudi Arabia, serving as inspiration for similar efforts worldwide.

Infants routine video electroencephalogram findings in a Saudi tertiary hospital

Objectives:

To report the existence and describe the non-epileptic abnormalities, interictal epileptiform discharges, and seizures in routine electroencephalograms (EEGs) of infants in a tertiary hospital out-patient neurophysiology clinics.

Methods:

This is a non-interventional, retrospective descriptive study that involved the review of 172 infants’ EEGs conducted from July 2018 to June 2019 in King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.

Results:

Total of 172 EEGs were reviewed; 152 routine EEGs for infants and 20 neonatal EEGs. Seventy-six (50%) EEGs were reported to be normal. Among the remaining EEGs, 54 were characterized by generalized slow background abnormalities (31.3 %), seven (4%) by background asymmetry, one (0.5%) by generalized low amplitude, and one (0.5 %) by an alternate trace that was dysmature for age. Interictal epileptiform discharges (IED) were present in 75 (43.6%) EEGs and they were focal in 72 (41.8%) EEGs, and generalized spike wave discharges were seen in only 3 (1.7%) EEGs with focal interictal epileptiform discharges. A diagnosis of hypsarrythmia was made from 15 (8.7%) EEGs. There were seizures in 11 (6.4%) EEGs, of which three were in neonates (15% of neonatal EEGs), and 8 in infants (4.6 % of infant EEGs).

Conclusions:

Fifty % of routine infants‘ EEGs had abnormalities and hypsarrythmia was the most common abnormal background associated with seizures. Ictal discharges in form of generalized electrodecremental pattern associated clinically with epileptic spasm was the most common type of seizures

A comprehensive review of epilepsy in the Arab world

PURPOSE

We conducted a comprehensive review of the epidemiology of epilepsy in the Arab world.

METHODS

Epidemiological literature about epilepsy from 22 countries of the Arab League was searched in French and English using several keywords (specific and wider) and combinations, individually for each country. The search was conducted on Google first and then on PubMed. The results are presented as counts, proportions, and medians along with 95% confidence intervals (CI). Unpaired t-test with unequal variance and regressions were performed, altogether and individually, for lifetime and active epilepsy prevalence as well as incidence.

RESULTS

Google provided 21 prevalence, four camp and nine incidence estimates while PubMed provided ten such estimates; none of them was identified by Google. No epidemiological data about epilepsy was found from 10/22 countries. Excluding pediatric studies, 13 prevalence estimates from six countries were identified. Including pediatric studies, 21 estimates from nine countries were found. Median lifetime and active epilepsy prevalence were 7.5/1000 (95% CI 2.6-12.3, range 1.9-12.9) and 4.4/1000 (95% CI 2.1-9.3, range 2.1-9.3), respectively, excluding pediatric studies (1984-2014, N=244081). Median incidence was 56.0/100,000 (n=9, N=122484, 95% CI 13.7-147.9, range 10.4-190).

CONCLUSION

The fact that no epidemiological data about epilepsy is available in the public domain for almost one half of all Arab countries offers opportunities for future research. This thorough review of existing literature demonstrates a prevalence of epilepsy three times higher than previously reported for this region. The median incidence is similar to other regions of the world, e.g. North America. Google yielded additional valuable sources not indexed in PubMed and provided pertinent references more quickly.

Cerebral palsy in Al-Quseir City, Egypt: prevalence, subtypes, and risk factors

Cerebral palsy (CP) is the most frequent cause of motor handicap. The present door-to-door survey was conducted in Al-Quseir City, Egypt, to investigate the epidemiology of CP. All inhabitants were screened by three neurologists. Medical and neurological examinations were performed for all residents and suspected cases of CP were confirmed by meticulous neurological assessment, brain magnetic resonance imaging, electroencephalography, and testing with the Stanford-Binet Intelligence Scale. Forty-six of 12,788 children aged ≤18 years were found to have CP, yielding a childhood prevalence of 3.6 (95% confidence interval 1.48-2.59) per 1,000 live births. Five adults (aged 19-40 years) among 13,056 inhabitants had CP, giving an adult prevalence of 0.4 (95% confidence interval 0.04-0.72) per 1,000. The risk factors for CP identified in this study were premature birth, low birth weight, neonatal jaundice, neonatal seizures, and recurrent abortion in mothers of children with CP.

Epidemiology of cerebral palsy in El-Kharga District-New Valley (Egypt)

Cerebral palsy (CP) is the most frequent cause of motor handicap among children. The present door to door (every door) study was conducted in El-Kharga District-New Valley to estimate the epidemiology of CP among children. Each child was subjected to complete medical and neurological examination to detect cases with CP. These diseased children were subjected to meticulous neurological and medical assessment, brain MRI, EEG and Stanford Binet (4th edition). It was found that 52 out of 25,540 children had CP yielding prevalence rate of 2.04/1000 (95% CI: 1.48-2.59) of living births. Mean age of children with CP, was 7.17±4.38years. The order of frequency of different subtypes of CP was as follows, 65.4% had spastic type, 26.9% mixed type and 3.8% for each ataxic and dyskinetic types of CP. The frequency of risk factors of CP in our study is prenatal complications (cyanosis, preterm, jaundice, birth weight and obstructed labor of mothers), first baby, similar condition and recurrent abortions.

The prevalence of neurological disorders in Saudi children: a community-based study

There are limited data on the pattern and prevalence of pediatric chronic neurologic conditions in the region. Therefore, the objective of this study was to establish the prevalence of these disorders in the Kingdom of Saudi Arabia. A multistage probability sampling design was used to select a random sample of Saudi households representative of the Saudi population. A total of 45 682 Saudi children were screened. Of these children, 313 had a chronic major neurologic disorder indicating a prevalence of 68.5 per 10 000 children, which was the highest among all chronic diseases in children. Mental retardation and cerebral palsy were the most common neurologic disorders among Saudi children with a prevalence rate of 26.3/10 000 and 23.4/10 000, respectively. The finding that major neurologic disorders are the most common pediatric chronic disorders in the Kingdom of Saudi Arabia indicates that priority should be given to research and education as well as health care planning.

Cerebral palsy: Incidence and clinical features in Saudi Arabia

The purpose of this work is to analyse the cerebral palsy (CP) incidence, aetiology, birthweight, types and/or subdiagnosis and associated impairments, individually or in combination, in children at Riyadh Military Hospital (RMH). The study covered the birth year period 1984 - 2003, during which 99,788 live births were recorded at Riyadh Military Hospital (RMH). Incidence ratio and clinical features of 412 positive cases of cerebral palsied children between 1 - 10 years old were investigated. Medical information was collected from patient files at the medical records department. The incidence of CP was 0.41%. The five intervals of the study period gave a pattern of decreasing percentage incidence. The case distribution according to birth weight, aetiology, duration and subdiagnoses was studied. It could be concluded that livebirth incidence of cerebral palsied patients in Saudi Arabia was relatively high as compared to most other studies. Severe disability due to cerebral palsy was associated with impairments such as mental retardation, epilepsy and visual impairments, often found in combinations.

Identifying children with neurological impairment and disability in resource-poor countries

BACKGROUND

The burden of neurological impairment (NI) in children living in resource-poor countries (RPCs) is unknown. This lack of data is caused by inappropriate case detection techniques. In RPCs, the most appropriate method should be inexpensive, simple, rapid and accurate. This article reviews methods used to identify children with NI and disability in RPCs, evaluating their effectiveness and suitability.

METHODS

A search of relevant articles was performed using the National Library of Medicine via PubMed and Medline search engines. In addition, bibliographies of reviews were also browsed to identify additional articles, particularly those from World Health Organization and United Nations sources and from government and unpublished reports. Key phrases used included impairment, disability or handicap and the following terms: identification, screening, prevalence and developing countries. Studies included were those that fulfilled the following criteria; performed in RPCs, presented data in detail to allow reanalysis and provided data on cost and validity of the methods.

RESULTS

Use of the national census, key informants and methods using rapid rural appraisal have low sensitivity and are not able to provide adequate information on diagnostic categories or risk factors. House-to-house surveys using questionnaires have high sensitivities (63-100%) in the detection of impairment, but this approach remains relatively expensive and cannot be applied to an entire population (e.g. a region or country) and is thus less useful for assessing the needs of disability. Furthermore, the sensitivity is decreased in the detection of some domains, e.g. cognition.

CONCLUSIONS

Most of the approaches used for identifying individuals with NI or disability suffer from inadequacies, the main ones being low sensitivity and underreporting. To assess the burden, nationwide censuses combined with surveys in selected areas of the country may be useful. These systems, however, require validation to establish their suitability.

Epilepsy in Colombia: Epidemiologic Profile and Classification of Epileptic Seizures and Syndromes

PURPOSE

A national study was performed in Colombia to determine the general and regional prevalence of epilepsy, clinical profiles, seizure types, and clinical syndromes.

METHODS

Based on the National Epidemiological Study of Neurological Diseases (EPINEURO), we evaluated and followed up for 1 year all the subjects with epilepsy from the National Sample. Clinical profiles were further assessed. Seizure types and epilepsy syndromes were established according to the international classifications.

RESULTS

General prevalence was found to be 11.3 per 1,000, with little variation among regions, except the eastern region, where prevalence was 23 per 1,000; prevalence for active epilepsy was 10.1 per 1,000. Women have a slightly greater (not statistically significant) risk. Most seizures are focal (partial), frequently with secondary generalization. The most frequent epilepsy syndrome encountered was partial symptomatic/cryptogenic (80%). Epilepsy onset in Colombia occurs most frequently in childhood.

CONCLUSIONS

Prevalence rates of epilepsy in Colombia are similar to those reported in nations with comparable developmental status and have diminished over time. The study presents the distribution of seizures and syndromes. The most frequent types are focal syndromes.

Epilepsy classification and factors associated with control in Saudi adult patients

There is insufficient information on the epilepsies in Saudi Arabia. The objectives were to classify the patients according to seizure types and epilepsies as well as to determine the factors associated with control. In a hospital-based study, clinical information, electroencephalographic and neuroimaging findings were utilized to classify the cases into seizure types and epilepsies according to ILAE criteria and to determine the factors statistically associated with control. In the study there were 826 patients (454 males and 372 females; mean age = 28.7 years; >80% below 30 years at onset). The seizure types were: generalized tonic-clonic (43.8%), partial seizure secondarily generalized (41.9%), myoclonic (8.4%), simple partial (1.3%), complex partial (1.3%) and absence (0.4%). About 15% of the classifiable epilepsies were symptomatic. Most symptomatic epilepsies occurred in people over the age of 50 years. One-year remission rate was 80% and the factors associated with control were: compliance, monotherapy, therapeutic drug level and seizure type. The results showed that epilepsy predominantly affected young adults and confirmed the association of partial epilepsy with clinical and CT abnormalities. The 1-year remission rate was comparable with reports from other studies as well as the factors associated with control in our patients.