Author Correction: Association of monomeric C-Reactive Protein (m-CRP) with hypothalamic neurons after CRP hippo-campal administration in a model of dementia

Correction to: European Review for Medical and Pharmacological Sciences 2022; 26 (22): 8713-8718. DOI: 10.26355/eurrev_202212_30543- PMID: 36524490-published online on December 15, 2022. After publication, the authors applied a correction to the funding statement: The authors extend their appreciation to the deputyship for Research & Innovation, Ministry of Education in Saudi Arabia for funding this research work through the project number (lFP-2020-36). There are amendments to this paper. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/30543.

Assessing causality in the association between neurocognitive gains and fasting

Fasting is associated with improvements in cognitive function, and triggers weight loss in human and animal models. In recent years, the connection between fasting, brain health, and cognitive function has increasingly proven deserving of attention from researchers. The objective of this review work is to highlight evidence supporting a positive association between fasting and enhanced cognition. We looked at the following database sources "The Cochrane Library, PubMed, EMBASE, Web of Science and Google Scholar" for present review article. All the studies based on the key words "impact of fasting", or "cognitive function" or "brain stimulation". Much of this evidence demonstrates that fasting results in enhanced performance in cognitive tests of memory and visuospatial processing, which rely heavily on hippocampal function. The mechanisms responsible for the cognitive improvements associated with fasting are not fully understood, although current evidence suggests neuroplasticity plays an important role. Maintaining the health and the functionality of neurologically and cognitively impaired individuals can be extremely costly. Higher life expectancy and ageing populations globally is anticipated to increase the prevalence of many non-communicable, chronic, progressive conditions including neurological disorders.

Association of monomeric C-Reactive Protein (m-CRP) with hypothalamic neurons after CRP hippo-campal administration in a model of dementia

OBJECTIVE

The ensuing ischemia due to the disruption of blood supply to the brain is one of the most common causes of stroke. Evidence suggests a clear association of the ischemic injury with vascular dementia and Alzheimer's disease (AD). In response to the brain ischemia, a cascade reaction starts leading to neuronal damage due to oxidative stress and other inflammatory mediators. A pilot study was done, which showed that following stroke, monomeric-C-reactive protein (mCRP) is expressed in large quantities around the infarcted zone and this CRP is able to induce neurodegeneration and inflammation potentially perpetuating dementia.

MATERIALS AND METHODS

We examined both patient brain samples and excised mouse brain tissue, previously injected with 1.75 mg/mL mCRP into the CA1 area of the hippocampus through the stereotactic surgical procedures and followed them over a period of over 6 months. The distribution of mCRP was examined through immunohistochemistry (mouse anti-human mCRP-specific antibodies 8C10).

RESULTS

We observed a novel finding: those micro vessels close to the injection location were strongly stained with mCRP only in the mice that had been injected with mCRP, indicating that this small blood vessel can spread it throughout the brain.

CONCLUSIONS

mCRP found in the brain after a hemorrhagic stroke promotes damage over a large area via the induction of inflammation and degeneration of perivascular compartments.

The Metabolic Role of Ketogenic Diets in Treating Epilepsy

Epilepsy is a long-term neurological condition that results in recurrent seizures. Approximately 30% of patients with epilepsy have drug-resistant epilepsy (DRE). The ketogenic diet (KD) is considered an effective alternative treatment for epileptic patients. The aim of this study was to identify the metabolic role of the KD in epilepsy. Ketone bodies induce chemical messengers and alterations in neuronal metabolic activities to regulate neuroprotective mechanisms towards oxidative damage to decrease seizure rate. Here, we discuss the role of KD on epilepsy and related metabolic disorders, focusing on its mechanism of action, favorable effects, and limitations. We describe the significant role of the KD in managing epilepsy disorders.

Defense mechanism responses to COVID-19

The COVID-19 pandemic has had a wide range of negative physical and mental impacts. This review begins with a theoretical explanation of the psychological defense mechanisms used to deal with the pandemic. It then discusses different categories of defense mechanisms and their roles in managing the impacts of psychological distress. The aim of this review is to highlight the various psychological defense mechanisms individuals use to deal with the pandemic and to discuss how adjustment mechanisms can protect individuals from internal and external threats by shielding the integrity of the ego (the mind) and helping individuals maintain their self-schema.

Sodium voltage-gated channel alpha subunit 9 mutation in epilepsy

In humans, gene mutations in voltage-gated sodium channels can cause a range of epileptic symptoms, including genetic (generalized) epilepsy with febrile seizures plus (GEFS+) and Dravet syndrome (DS). The SCN9A is a member of the SCN9 gene family that encodes sodium transporter proteins. In the current case report, we delineate a 12-year-old patient who was referred to a pediatric neurology clinic for infantile-onset generalized epileptic seizures and progressive neurodevelopmental delay. Novel heterozygous mutations c.4702A>C (p.Asn1568His) in the SCN9A gene, and c.65G>A (p.Arg22Gln) in the MLC1 gene were detected using targeted next-generation gene sequencing. The replacement of Histidine (His) with Asparagine (Asn) at position 1568 in the topological domain of SCN9A channel protein provides new insights into the impaired excitation and inactivation patterns of sodium channels. The case report adds this new patient with genetic link of SCN9A variants with progressive myoclonic epilepsy and cognitive difficulties.

SLC gene mutations and pediatric neurological disorders: diverse clinical phenotypes in a Saudi Arabian population

The uptake and efflux of solutes across a plasma membrane is controlled by transporters. There are two main superfamilies of transporters, adenosine 5'-triphosphate (ATP) binding cassettes (ABCs) and solute carriers (SLCs). In the brain, SLC transporters are involved in transporting various solutes across the blood-brain barrier, blood-cerebrospinal fluid barrier, astrocytes, neurons, and other brain cell types including oligodendrocytes and microglial cells. SLCs play an important role in maintaining normal brain function. Hence, mutations in the genes that encode SLC transporters can cause a variety of neurological disorders. We identified the following SLC gene variants in 25 patients in our cohort: SLC1A2, SLC2A1, SLC5A1, SLC6A3, SLC6A5, SLC6A8, SLC9A6, SLC9A9, SLC12A6, SLC13A5, SLC16A1, SLC17A5, SLC19A3, SLC25A12, SLC25A15, SLC27A4, SLC45A1, SLC46A1, and SLC52A3. Eight patients harbored pathogenic or likely pathogenic mutations (SLC5A1, SLC9A6, SLC12A6, SLC16A1, SLC19A3, and SLC52A3), and 12 patients were found to have variants of unknown clinical significance (VOUS); these variants occurred in 11 genes (SLC1A2, SLC2A1, SLC6A3, SLC6A5, SLC6A8, SLC9A6, SLC9A9, SLC13A5, SLC25A12, SLC27A4, and SLC45A1). Five patients were excluded as they were carriers. In the remaining 20 patients with SLC gene variants, we identified 16 possible distinct neurological disorders. Based on the clinical presentation, we categorized them into genes causing intellectual delay (ID) or autism spectrum disorder (ASD), those causing epilepsy, those causing vitamin-related disorders, and those causing other neurological diseases. Several variants were detected that indicated possible personalized therapies: SLC2A1 led to dystonia or epilepsy, which can be treated with a ketogenic diet; SLC6A3 led to infantile parkinsonism-dystonia 1, which can be treated with levodopa; SLC6A5 led to hyperekplexia 3, for which unnecessary treatment with antiepileptic drugs should be avoided; SLC6A8 led to creatine deficiency syndrome type 1, which can be treated with creatine monohydrate; SLC16A1 led to monocarboxylate transporter 1 deficiency, which causes seizures that should not be treated with a ketogenic diet; SLC19A3 led to biotin-thiamine-responsive basal ganglia disease, which can be treated with biotin and thiamine; and SLC52A3 led to Brown-Vialetto-Van-Laere syndrome 1, which can be treated with riboflavin. The present study examines the prevalence of SLC gene mutations in our cohort of children with epilepsy and other neurological disorders. It highlights the diverse phenotypes associated with mutations in this large family of SLC transporter proteins, and an opportunity for personalized genomics and personalized therapeutics.

The battle against the COVID-19 pandemic- a perspective from Saudi Arabia

COVID-19 has emerged as the world's biggest challenge that has not only threatened human lives but also had an immense impact on the economy, safety and religious practices. The situation has worsened due to the lack of proper guidelines for fighting the sudden unexpected outbreaks. The world was not prepared for this situation. Muslims make up the largest religious group in the world, and Saudi Arabia is the center of religious life for Muslims. The eye of the Muslim world is turned toward the measures and reforms that the Saudi state is implementing during this pandemic, including strict curfews and quarantines with heavy fines and punishments for violations. This review highlights some important steps the Saudi government is taking and their impact on controlling the COVID-19 outbreak.

The prevalence of seizures in children with developmental delay

Objectives:

To study the prevalence of seizures in children with GDD and identify the characteristics of such patients; to examine the association of GDD with epilepsy and to determine the effect of certain risk factors on this association.

Methods:

A retrospective cross-sectional study conducted at the pediatric neurology and developmental assessment clinic at King Fahad specialist hospital (KFSH), Saudi Arabia. All data were collected by reviewing the electronic medical records of 200 pediatric patients who presented with global developmental delay from February 2016 to April 2018.

Results:

The sample includes 200 children (113 males, 87 females) aged zero to 12 years. The largest group of participants came from the Dammam region, representing 27.5% of the sample. The prevalence of epilepsy in GDD patients was 56%; the epilepsy and non-epilepsy groups differed significantly in age. The most common type of seizure was generalized onset motor, which were observed in 37.5% of the sample. Problems during labor occurred in 15% of the sample; consanguineous marriage occurred in 61.6% of the participants. Neither of these factors differed significantly in the epilepsy and non-epilepsy groups. Advanced paternal age did differ significantly in the two groups (p=0.003).

Conclusion:

The prevalence of epilepsy is high in children with GDD, and of the factors studied here, the most significant variables affecting this correlation are the type of seizure and advanced paternal age.

Healthcare workers' knowledge and attitudes towards COVID-19 in Saudi Arabia

OBJECTIVE

The world is facing a devastating challenge in the COVID-19 (coronavirus disease 19) outbreak.  Healthcare workers (HCWs) provide the first line of defense against any disease outbreak. Thus, the present study is designed to assess HCWs' attitudes towards, knowledge of, and awareness of COVID-19.

MATERIALS AND METHODS

A cross-sectional observational study was conducted using an online survey on social media; the participants were 597 adults. The study was conducted from March to April 2020. The questionnaire was randomly administered on Arabic-language social media applications; the 26-item survey assessed knowledge levels, attitudes, and practices.

RESULTS

The analysis includes 597 complete responses from HCWs; participants included physicians, nurses, medical students, and pharmacists. Most participants were females aged 18 to 25 years. Most participants agreed that the virus can spread via direct and indirect contact. Most participants indicated that they wash their hands; avoid touching their eyes, nose, or mouth; and avoid crowded places to protect themselves against infection. Most indicated that a bat was the original source of the virus. Most participating HCWs indicated that the symptoms of COVID-19 include fever, cough, and shortness of breath. Most of the participants also indicated that there is no specific treatment for patients infected with COVID-19.

CONCLUSIONS

The findings of this work can support the design of effective measures to prevent and control COVID-19 infections during the pandemic. The results also highlight where improvement is needed to HCWs' knowledge of and attitudes towards COVID-19; the findings also highlight the best healthcare practices regarding this illness.

Incidence of potential adverse events during hospital-based ketogenic diet initiation among children with drug-resistant epilepsy

OBJECTIVE

Due to the possibility of serious adverse events (AE), patients are commonly admitted to hospital for 3-5 days for ketogenic diet (KD) initiation. This study examined the incidence of potential AE during admission for KD initiation to investigate the possibility of safely initiating a KD at home.

METHODS

Children with drug-resistant epilepsy (DRE) who were admitted to hospital for 5 days for KD initiation were retrospectively studied.

RESULTS

A total of 66 children (59% female) were analyzed. The mean age at the initiation of the KD was 48.0 ± 38.4 months, and the mean weight was 14.6 ± 6.3 kg. The median number of anticonvulsant medications used at the time of KD initiation was 3. The etiology of the DRE was structural in 4.5%, hypoxic ischemic encephalopathy in 10.6%, genetic/metabolic in 31.8%, acquired in 10.6%, and unknown in 42.2%. The potential AE occurred in 28.7% of patients, including hypoglycemia (20%), hypoactivity (6.1%), somnolence (3%), and vomiting (7.6%). A univariate analysis of the clinical characteristics of the AE and no AE groups showed a statistically significant difference in weight (P = 0.003) and age (P = 0.033). The concurrent use of topiramate was found to have a near-significant association (P = 0.097) between the groups. The groups' urine ketone levels on all 5 days were compared, and a statistically significant difference was found on day 3 (P = 0.026). A statistically significant difference in the serum bicarbonate levels (P = 0.038) was found between the patients taking topiramate and those not taking it.

SIGNIFICANCE

The incidence of AE during admission for KD initiation was found to be low. The AE either required no intervention or were easily managed with simple interventions. Thus, in carefully selected patients, it may be possible to initiate a KD at home if the parents are adequately prepared and monitored.

MRI Evaluation of Global Developmental Delay: A Retrospective Study

Introduction: Global developmental delay (GDD) is defined as a significant delay in one or more developmental domains. Aims and Objectives: To study the prevalence of normal and abnormal magnetic resonance imaging (MRI) in pediatric patients presenting with GDD, and how abnormal MRI helps in the diagnosis of children with GDD. Materials and Methods: This was a retrospective observational study conducted at the King Fahad Specialist Hospital Dammam. MRI of the brain was conducted on 170 patients who were referred by the Pediatric Neurology Department between February 2016 and April 2018. Results: Normal MRI findings were seen in 45.3% and 54.7% had abnormal findings. The ventricles and white matter, mainly the corpus callosum, were the most commonly affected anatomical structures. In 15 (16%) patients, MRI enabled a direct diagnosis, and in 22 (23.6%) MRI suggested a diagnosis which was confirmed by further investigation. Conclusion: The clinical diagnosis of GDD should not be the end point, but rather a springboard for an effective search for causal factors. MRI is the best investigation with a high yield in such patients.

Cognitive function assessment during 2 mA transcranial direct current stimulation in DLPFC in healthy volunteers

Although cognitive function has been reported to change following the anodal transcranial direct current stimulation (tDCS) but still variable results have been reported in healthy subject and there is paucity of data on the cognitive effects of online tDCS. Therefore, we aimed to assess the online effect of tDCS over the left dorsolateral prefrontal cortex (DLPFC) on cognitive function and obtain safety data in healthy adults. We recruited 36 healthy (20 male) participants for this double-blind, sham-controlled parallel design. We used Stop Signal Task (SST) Go Trial and Pattern Recognition Memory (PRM) tests to evaluate cognitive function during 2 mA (20 min) anodal or sham tDCS stimulation over the left DLPFC. In active conditions, left dorsolateral prefrontal cortex was selected for electrode placement with reference over right supraorbital cortex. All related tasks were done during the online tDCS section in both groups (active/sham). There were statistically significant differences in cognitive function according to the PRM test (P = 0.003), SST (P = 0.021), and SST correct response time on Go Trials (P = 0.02) during active stimulation compared to the sham group. Our results reveal that cognitive performance is affected by a single dose of active online tDCS over DLPFC area compared to sham stimulation. In our study, tDCS is well-tolerated and safe that further supports the safety of tDCS in local healthy population.

Epilepsy in patients with EAST syndrome caused by mutation in the KCNJ10

OBJECTIVE

EAST syndrome comprises of epilepsy, ataxia, sensorineural deafness, and tubulopathy. It is caused by a mutation in KCNJ10 gene. Less than thirty cases have been reported in the literature with emphasis on genetic mutation and renal tubulopathy. In this article, our goal is to present a comprehensive description of epilepsy and its management. A literature review is also presented to consolidate and compare our findings with the previously reported cases.

METHODS

Retrospective chart review was done to collect patient data. Research clinic was organized to obtain missing data. Molecular genetic testing was done at the CGC Genetics Laboratory. Electroencephalogram (EEG) was done for all patients and interpreted by a pediatric epileptologist and brain MRI was reviewed by a pediatric neuroradiologist. Developmental assessment was done by a developmental pediatrician using Griffiths Mental Developmental Scale.

RESULTS

In patients with EAST syndrome, seizure is the first symptom occurring around 3-4 months of age. Most common seizure type was generalized tonic clonic (GTC). Usually, the seizures were brief lasting <3 min but few patients also presented with status epilepticus especially when the medication was weaned. Carbamazepine (CBZ) was found to be effective in most cases. Lamotrigine (LTG), valproic acid (VPA), and topiramate (TPM) were also found to be helpful. Routine EEGs were usually normal or showed non-specific findings. In few patients, EEG showed background slowing. Brain MRI revealed hyperintensity in the dentate nuclei in some patients, and quantitative volumetric analysis studies showed volume loss in different regions of the brain especially the cerebellum. All our five patients have the same homozygous c.170C>T (p.Thr57Ile) missense mutation in KCNJ10 gene.

CONCLUSION

This article provides the readers with an understanding of the natural history of epilepsy in this syndrome to help in early recognition, avoid unnecessary investigations, and provide the best treatment for seizures. It also helps the physicians to share the prognosis of this rare syndrome with the parents.

Pediatric Neurology Workforce in Saudi Arabia

Background The availability of pediatric neurologists remains a global problem. Strategic planning and tackling issues related to optimizing the care of children with neurologic disorders depend on the workforce, which we aim to evaluate in this study.

Method Physicians practicing in the field of pediatric neurology in Saudi Arabia were identified from the database of national societies. A structured 30-item online survey was designed to examine their clinical practice, experience, and availability of supporting services.

Results A total of 56 pediatric neurologists completed the survey, mostly (48%) practicing in the capital city of Riyadh. Many of them worked alone (30%) or with only one other colleague (21%). Based on their responses, the estimated total number of pediatric neurologists across the country was 75 with a ratio of 1.06 pediatric neurologists per 100,000 children < 15 years of age. They had very busy services with 66% evaluating > 15 patients per clinic and 79% reporting difficulties in finishing on time. The majority (87.5%) felt overwhelmed, which correlated with working alone (p = 0.002), having no assistant consultant (p = 0.039), and having no access to international sent-out laboratories (p = 0.02). The majority (94.5%) needed additional help in dealing with the volume and complexity of their patients, which correlated with feeling overwhelmed (p = 0.006).

Conclusion Although the total number of pediatric neurologists across Saudi Arabia has improved significantly over the last decade, their distribution remains uneven leading to shortages in many regions. This adds to the excessive workload and affects the quality of the provided services.