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Dahab L, Dahab L, Abdelgadir K, Obeid T, Dey S, Ahmed M, Al-Safi W, Mohamed A, Lungba R, Abu Bakr A, Abdelrahman N. Effect of COVID-19 Pandemic on Depression and Medications Use on Nursing Home Residents. J Am Med Dir Assoc 2021; 22:B20-B21. [PMID: 34287166 PMCID: PMC7902226 DOI: 10.1016/j.jamda.2021.01.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Obeid T. First unprovoked seizure limitation and applicability in developing countries. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Obeid T, Hamzeh AR, Saif F, Nair P, Mohamed M, Al-Ali MT, Bastaki F. Identification of a novel homozygous UNC80 variant in a child with infantile hypotonia with psychomotor retardation and characteristic facies-2 (IHPRF2). Metab Brain Dis 2018; 33:869-873. [PMID: 29430593 DOI: 10.1007/s11011-018-0200-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
Abstract
The UNC80 gene encodes for a large component of the NALCN sodium-leak channel complex that regulates the basal excitability of the nervous system. In this study, we report on a novel homozygous mutation in UNC80 in a Palestinian-Emirati patient suffering infantile hypotonia with psychomotor retardation and characteristic facies. This mutation was detected by whole exome sequencing and confirmed using Sanger sequencing in the patient-parents trio. Numerous elements in the patient's phenotype were in agreement with the few reported cases of UNC80 mutations; however there are some notable differences. We present comprehensive clinical and molecular accounts of this mutation in addition to a full review of previously reported patients of UNC80 mutations.
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Affiliation(s)
- Tasneem Obeid
- Department of Applied Biology/ Biotechnology Program, University of Sharjah, College of Sciences, P.O. Box 27272, Sharjah, United Arab Emirates.
| | | | - Fatima Saif
- Pediatric Department, Latifa Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Pratibha Nair
- Centre for Arab Genomic Studies, Dubai, United Arab Emirates
| | - Madiha Mohamed
- Pediatric Department, Latifa Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | | | - Fatma Bastaki
- Pediatric Department, Latifa Hospital, Dubai Health Authority, Dubai, United Arab Emirates
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Awada A, Daif A, Obeid T, Al Rajeh S. Nontraumatic cerebral hemorrhage in the young: a study of 107 cases. J Stroke Cerebrovasc Dis 2009; 7:200-4. [PMID: 17895082 DOI: 10.1016/s1052-3057(98)80008-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/1997] [Accepted: 10/21/1997] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Reports on intracerebral hemorrhage (ICH) in the young are rare, and information on the cause and prognosis of ICH in this age-group is sparse. METHODS All cases of ICH admitted to three major hospitals in Saudi Arabia over a 15-year period were retrospectively reviewed. Patients aged between 6 months and 45 years at stroke onset were studied. Pooling of our data with those published from other centers was used for final analysis. RESULTS One hundred seven cases (69 male, 38 female), including 12 children younger than 10, were analyzed. The causes of hemorrhage were as follows: arteriovenous malformations (AVMs), 23%; systemic hypertension, 20%; blood dyscrasias, 16%; berry aneurysms, 8%; other causes, 7%. No cause was found in 26%. Sixty-two percent of the ICHs were lobar and 3% multiple. Early death rate was high (27%). Twelve percent of the patients were lost to follow-up, and only 26% returned to a state of complete autonomy. CONCLUSION The pooling of the causative data from our cases and the 253 others reported in the literature showed that even before 45 years of age systemic hypertension is the leading cause of ICH. It accounts for approximately 30% of the cases, with AVMs (20%) being next. The pooled overall early mortality rate is approximately 20%, and only one third of the patients return to independent living.
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Affiliation(s)
- A Awada
- King Fahad National Guard Hospital Riyadh, Saudi Arabia
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Tadmouri GO, Nair P, Obeid T, Al Ali MT, Al Khaja N, Hamamy HA. Consanguinity and reproductive health among Arabs. Reprod Health 2009; 6:17. [PMID: 19811666 PMCID: PMC2765422 DOI: 10.1186/1742-4755-6-17] [Citation(s) in RCA: 326] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 10/08/2009] [Indexed: 12/11/2022] Open
Abstract
Consanguineous marriages have been practiced since the early existence of modern humans. Until now consanguinity is widely practiced in several global communities with variable rates depending on religion, culture, and geography. Arab populations have a long tradition of consanguinity due to socio-cultural factors. Many Arab countries display some of the highest rates of consanguineous marriages in the world, and specifically first cousin marriages which may reach 25-30% of all marriages. In some countries like Qatar, Yemen, and UAE, consanguinity rates are increasing in the current generation. Research among Arabs and worldwide has indicated that consanguinity could have an effect on some reproductive health parameters such as postnatal mortality and rates of congenital malformations. The association of consanguinity with other reproductive health parameters, such as fertility and fetal wastage, is controversial. The main impact of consanguinity, however, is an increase in the rate of homozygotes for autosomal recessive genetic disorders. Worldwide, known dominant disorders are more numerous than known recessive disorders. However, data on genetic disorders in Arab populations as extracted from the Catalogue of Transmission Genetics in Arabs (CTGA) database indicate a relative abundance of recessive disorders in the region that is clearly associated with the practice of consanguinity.
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Abstract
OBJECTIVES To describe the lateral approach to the popliteal artery in reconstructions after soft tissue sarcoma resection in the thigh. DESIGN Case reports. Subjects Four patients with soft tissue sarcoma. METHODS Extraanatomic reconstruction of the resected artery and vein in the medial part of the thigh was performed. Vessel reconstruction was performed before tumor resection to avoid leg ischemia. RESULTS In all four patients the artery was replaced by using the contralateral saphenous vein, while the femoral vein was replaced in two cases using e-PTFE. Post-operative complications included one large lymphatic collection and a deep wound infection. Arterial primary graft patency was 100% after 1-7 years. Patency of the e-PTFE-venous graft was 0% without further consequences. CONCLUSIONS The extraanatomic lateral replacement of the vessels in the thigh is an elegant method in difficult vascular reconstructions after soft tissue sarcoma resection or debridement for deep vascular infections.
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Affiliation(s)
- P Stierli
- Centre of Vascular Surgery, Aarau, Switzerland.
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Eugster T, Huber A, Obeid T, Schwegler I, Gürke L, Stierli P. Aminoterminal propeptide of type III procollagen and matrix metalloproteinases-2 and -9 failed to serve as serum markers for abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 2005; 29:378-82. [PMID: 15749038 DOI: 10.1016/j.ejvs.2004.12.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2004] [Accepted: 12/07/2004] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Matrix-metalloproteinase (MMP)-2 and -9 and aminoterminal propeptide of type III collagen (NIIINP) have been reported to be elevated in patients with abdominal aortic aneurysm (AAA). The aim of our study was to test NIIINP, MMP-2 and -9 as potential serum markers for AAA in a large population group at risk for AAA. METHODS Fifty-five to 70 year old men were screened for AAA by abdominal ultrasound. Simultaneously, blood samples were taken and the patients were interviewed for known risk factors for AAA. Patients with a dilatation of the infrarenal aorta of > or =25mm (Group 1, n=76) were compared to randomly assigned patients with normal aortic diameters (Group 2, n=83). A third group consisted of patients scheduled for operation of AAA (n=19). RESULTS A total of 987 men were investigated with ultrasound. Seventy-six (7.7%) had an aortic dilatation > or =25mm. Aortic dilatation was correlated with age (P=0.0001). However, serum levels of NIIINP and MMP 2 were not different between the three groups of patients. For MMP-9 there was a weak inverse correlation with lower serum levels in patients with aortic dilatation (P=0.043). CONCLUSIONS Both MMP-2 and -9 and NIIINP failed to show relevance as serum markers for aortic dilatation. Our results are, therefore, in contradiction to previous published results. AAAs cannot be diagnosed with a simple blood test.
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Affiliation(s)
- T Eugster
- University Vascular Center Aarau/Basel, University Hospital, CH-4031 Basel, Switzerland.
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Abstract
We report two hypertensive females, one suffering from chronic renal failure and on regular dialysis, the other with eclampsia. Both developed new onset seizures. The patients' MRI of brain showed signals consistent with the reversible posterior leukoencephalopathy syndrome (RPLES), but with the signals seen only in the hemisphere where the seizures predominated. The anatomic correlation of the clinical and imaging findings supports the notion that seizures have a major role in the genesis and evolution of RPLES.
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Affiliation(s)
- T Obeid
- Department of Medicine, King Khalid National Guard Hospital, Jeddah, Saudi Arabia.
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Eugster T, Stierli P, Guerke L, Obeid T, Hess P. Present status of infrainguinal arterial bypass procedures following an all autogenous policy--long-term results of a single center. Swiss Surg 2002; 8:171-5. [PMID: 12227110 DOI: 10.1024/1023-9332.8.4.171] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The direction of vein grafts for infrainguinal arterial reconstruction is controversial. Long-term results of a single center following an all autogenous tissue policy in infrainguinal arterial reconstruction are reported with special attention to possible advantages for the in situ and non-reversed bypass using angioscopy. METHODS From 10/88 until 12/00 540 bypasses with autogenous veins were performed on 497 patients. Veins were used in a non-reversed or in-situ direction, valve disruption was performed under angioscopic control. All grafts were prospectively included in our data base and follow-up was scheduled in our vascular lab before discharge and after 3, 6, 9, 12, 24 etc. months. RESULTS Primary patency of all bypasses after 108 months was 55.2%, primary assisted 76.9% (SE +/- 9.87), survival 58.4% (SE +/- 8.88) and limb salvage 81.3% (SE +/- 9.75). Perioperative mortality was 0.9% (5 pat). Patency rates (primary assisted patency) after 72 months were 81.7% (98.2%) for supragenicular, 61.5% (79.4%) for infragenicular and 56.6% (78.1%) for tibial anastomoses and for pedal reconstructions after 48 months 49.3% (68.6%). CONCLUSION Reviewing the literature neither the in situ and non-reversed nor the reversed grafts yielded better long-term results. Absence of size mismatch may be an advantage in smaller veins. Angioscopy may detect unsuspected vein disease.
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Affiliation(s)
- T Eugster
- Surgical Clinic Kantonsspital Aarau, Basle.
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Abstract
OBJECTIVES the effect of gender on the long-term results of infrainguinal arterial reconstruction are poorly investigated. METHODS all patients undergoing infrainguinal arterial reconstruction with an autogenous vein are as 11 years period was prospectively evaluated. RESULTS four hundred and fifty reconstructions (292 man, 160 women) were performed as on 416 patients. Thirty-day mortality was 1.1% (n=5). Women were on average older (74 vs 68; p<0.001) and disease was more advanced (81 vs 68%,p =0.013 with stage of critical ischaemia). Primary (58 vs 61%) and primary assisted patency rates (82 vs 84%) were comparable. Limb salvage and survival after 60 months were not different. On multivariate analysis age and stage of the disease were independent variables for patency and survival. Diabetes and gender reached statistical significance as predictors of limb salvage only. CONCLUSION age and stage of the disease were independent predictors for patency and survival, diabetes and gender for limb salvage.
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Affiliation(s)
- T Eugster
- Vascular Unit, Kantonsspital Aarau/University of Basle, CH-4031, Basel, Switzerland
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Abstract
PURPOSE To evaluate the relationship between people with epilepsy and birth order. METHODS A case-control study of 336 epileptics, 15 years and above, and their 1961 full siblings. The data was analysed by birth order and then stratified by sibship size. The 95% confidence interval (CI) for each odds ratio (OR) was obtained. ORs were calculated in the 259 probands in whom the seizure and epileptic syndrome were classifiable against their corresponding 1313 siblings. RESULTS The OR in birth order 1 is 2.08 (1.6-2.8) on comparing probands to their unaffected siblings. In birth order 3 the OR was 1.64 (1.2-2.2) and ORs declined as birth order increased. The chi-square test for the decline was significant P < 0.05. OR in birth >2 in probands against unaffected sibs was 0.42 (0.2-0.62) in partial seizures and 0.27 (0.17-0.43) in the cryptogenic category, 86% of whom had partial seizures. CONCLUSION In spite of some limitations in the study it seemed that there is a significant association between low birth order and the risk of epilepsy when all cases were computed together. The cryptogenic type showed the clearest association between low birth order and the likelihood of epilepsy.
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Affiliation(s)
- T Obeid
- Neurology Section, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia.
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Abstract
We report two patients with severe radiculopathy due to elevated intracranial pressure (ICP) resulting from idiopathic intracranial hypertension (IHH) in one, and cerebral venous sinus thrombosis (CVT) in the other. Our aim is to document this unique association, which escaped diagnosis in both patients.
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Affiliation(s)
- T Obeid
- King Khalid and King Fahad National Guard Hospitals, Jeddah, Kingdom of Saudi Arabia.
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Obeid T, Mousali Y, Wali S, Samman Y, Gasim A, Osoba A. Paradoxical enlargement of lymph nodes during therapy of central nervous system tuberculosis. Ann Saudi Med 1999; 19:530-2. [PMID: 17277474 DOI: 10.5144/0256-4947.1999.530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- T Obeid
- Departments of Medicine, Microbiology and Pathology, King Khalid National Guard Hospital, Jeddah, Saudi Arabia
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Obeid T, Awada A, Sayes N, Mousali Y, Harris C. A unique effect of clonazepam on frontal lobe seizure control. Seizure 1999; 8:431-3. [PMID: 10600586 DOI: 10.1053/seiz.1999.0321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
In a 16-year-old female, clonazepam (CZP) changed randomly occurring intractable tonic seizures of frontal lobe origin to a few sleep seizures when used as an adjunctive therapy. The significance of this change in the seizure pattern is discussed with an explanation of possible pathophysiologic mechanism.
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Affiliation(s)
- T Obeid
- Neurology Sections, King Khalid and King Fahad National Guard Hospitals, Jeddah, Kingdom of Saudi Arabia
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Abstract
OBJECTIVES To determine the profile of late epileptic seizures following cerebral infarcts and the predictive clinical and radiological factors associated with their development. METHODS We compared 86 patients who developed late seizures after cerebral infarction with 285 similar patients who did not develop seizures for at least 1 year after their stroke. Patients who had seizures only at the onset of the stroke were excluded. Odds' ratios were used for statistical analysis. RESULTS Simple partial, and mainly motor seizures, with or without secondary generalization, accounted for 80% of the classifiable seizures but it was not possible to determine the seizure type in half of the cases. Factors that appeared to be predictive of seizure development were the presence of large cortical infarcts and the presence of apparently preserved cerebral tissue within the infarcted area. Seizures were rare in patients with lacunar infarction but the presence of associated leukoaraiosis increased the risk. The risk was also increased in patients with other medical problems known to lower seizure threshold, such as renal failure.
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Affiliation(s)
- A Awada
- Neurology Section, King Fahd National Guard Hospital, Riyadh, Saudi Arabia
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Abstract
A 24-year-old woman with previously known pseudotumor cerebri syndrome (PTCS) presented with severe pain in the neck and shoulders followed by the classical symptoms and signs of bilateral brachial neuritis. At the same time, there was a recurrence of the PTCS which had been in remission for more than one-and-a-half years. Despite treatment with high doses of methylprednisolone, intravenous immunoglobulins and repeated cerebrospinal fluid drainage, both brachial plexopathy and the PTCS continued to worsen. Both lumbosacral plexuses became involved and the visual acuity deteriorated to a level such that a lumboperitoneal shunt had to be inserted. The neurological condition started to improve progressively after 8 weeks. This case is, to our knowledge, the first where brachial plexopathy has been described in association with a PTCS. Although the pathogenesis of this association is not clear, there are enough data to suggest the existence of a continuum between extended brachial plexopathy and Guillain Barre syndrome, with which PTCS has been associated in some instances.
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Affiliation(s)
- A Awada
- Neurology Section, Department of Medicine (1443), King Fahd National Guard Hospital, POB 22490, Riyadh 11426, Saudi Arabia
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Tanimu DZ, Obeid T, Awada A, Huraib S, Iqbal A. Absence status: an overlooked cause of acute confusion in hemodialysis patients. J Nephrol 1998; 11:146-7. [PMID: 9650122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Epileptic seizures are a known complication of uremia, but non-convulsive seizures appear to be rare. We describe a patient with absence status presenting with acute confusion who responded well to intravenous diazepam. Attention is drawn to this rare cause of acute confusional state in the hemodialysis population.
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Affiliation(s)
- D Z Tanimu
- Section of Nephrology, King Fahad National Guard Hospital, Saudi Arabia
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Obeid T, Awada A. Long-term prognosis of typical childhood absence epilepsy. Neurology 1997; 49:1187. [PMID: 9339731 DOI: 10.1212/wnl.49.4.1187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Awada A, Daif A, Obeid T, Al Rajeh S. 4-07-08 Cerebral hemorrhage in the young. A study of 107 cases. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)85917-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Awada A, Obeid T. 5-17-03 Factors associated with uncontrolled epileptic seizures: Experience from a population-based hospital in Saudi Arabia. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)86354-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Obeid T, Awada A. 1-17-01 Epileptic seizures and the risks of driving. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)84940-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Obeid T, Awada A, Huraib S, Quadri K, Abu-Romeh S. Pseudotumor cerebri in renal transplant recipients: a diagnostic challenge. J Nephrol 1997; 10:258-60. [PMID: 9364317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We describe two patients with renal transplants who developed pseudotumor cerebri (PTC) in the course of their follow-up. They illustrate the diagnostic challenge in such situations. Patients with renal transplants usually have many other associated conditions which may lead to headache, visual disturbances or papilledema. A high index of suspicion is necessary for prompt diagnosis and management of this rare and serious but treatable combination.
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Affiliation(s)
- T Obeid
- Neurology Section, King Fahd National Guard Hospital, Riyadh, Saudi Arabia
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Abstract
PURPOSE To determine the reason that one-quarter to one-third of epileptic women experienced an increased number of seizures during pregnancy. The cause of this increase is not always clearly understood and the principle emphasis of the literature is on the pregnancy-associated changes of anticonvulsant pharmacokinetics. METHODS Two patients presented with recurrent seizures occurring only during pregnancy. Both had MRI findings typical of cavernous angiomas of the temporal lobe. RESULTS In addition to changes in anticonvulsant pharmacokinetics, potential mechanisms underlying the exacerbation of seizures from a vascular malformation during pregnancy include effects of estrogen on temporal structures critically involved in epileptogenesis and changes within the malformation itself secondary to direct actions of estrogen and the hemodynamic changes of pregnancy. CONCLUSIONS The possibility of an occult lesion such as cavernous angioma should be considered for seizures occurring during pregnancy. Even in the presence of a normal CT scan, an MRI investigation should be pursued, despite the ill-defined fears of MRI in pregnancy.
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Affiliation(s)
- A Awada
- Section of Neurology, King Fahd National Guard Hospital, Riyadh, Saudi Arabia
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Affiliation(s)
- T Obeid
- Neurology Division, King Fahad National Guard Hospital, Riyadh, Saudi Arabia
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Awada A, Amene P, Al Rajeh S, Obeid T. Carotid bruits and ischemic cerebrovascular disease. Ann Saudi Med 1996; 16:218-20. [PMID: 17372477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Affiliation(s)
- A Awada
- Divisions of Neurology, and Internal Medicine, King Fahad National Guard Hospital, Riyadh, Saudi Arabia
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Abstract
The angiographic findings in 100 Saudi patients with carotid ischemic cerebrovascular disease (CVD) (transient ischemic attacks (TIA) or strokes) were retrospectively reviewed. These patients were representative of all patients with similar disorders in the terms of sex, frequency of diabetes mellitus and ischemic heart disease. They were, however, significantly younger, smoked more, had more cervical bruits and less atrial fibrillation. Analysis of the data showed that a significant stenosis (> 70%) of the carotid artery origin was found only in 12% of TIA cases, 4% in the lacunar infarction cases and 6% of the large infarction cases on the symptomatic side and only in one case of TIA in the asymptomatic side. These frequencies were significantly lower than those found in similar studies performed in western countries. This study suggests that stenoses and occlusions of extracranial carotid artery plays a smaller role in the pathogenesis of ischemic CVD in Saudis than in Caucasians. The low consumption of cigarettes among elderly and females may be one of the explanations.
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Affiliation(s)
- S Al Rajeh
- Division of Neurology, King Fahad National Guard Hospital, Riyadh, Saudi Arabia
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Riedtmann HJ, Obeid T, Aeberhard P, Sakmann P. [Fasciola hepatica--a unusual cause of acute cholecystitis with cholestatic jaundice]. Schweiz Med Wochenschr 1995; 125:1642-8. [PMID: 7481618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A 29-year-old patient was admitted with acute abdomen in the 17th week of pregnancy. History revealed two episodes of colic in the right hypochondriac area during the previous six months, but no other abdominal complaints. Clinically the picture was that of acute cholecystitis. Laboratory findings included an elevated white cell count, a slight elevation of serum transaminases and a marked increase of serum alkaline phosphatase and bilirubin. Echographically there were dilated intra- and extrahepatic bile ducts containing two hyperechogenic elements without casting an acoustic shadow. A hydrops of the gallbladder with sludge and a thickening of the wall could also been seen. Because of pregnancy an ERCP could not be performed due to the need for X-ray, so we had to resort to open surgery. Under tocolytic and antibiotic shielding we carried out open cholecystectomy and choledochoscopic exploration of the common bile duct. Using a Fogarty balloon catheter we extracted two live, adult liver flukes and placed a T-tube in the duct. Because of positive fecal probes for fasciola eggs the T-tube had to be left in place until childbirth. Afterwards we performed a pre-cut-papillotomy by ERCP and took the T-tube out, having confirmed a clear duct on a T-tube-cholangiogram. With negative fecal probes and the eosinophilia on the white cell count returning to normal, we decided against the planned chemotherapy and assumed self-healing of the disease. The patient has been well since.(ABSTRACT TRUNCATED AT 250 WORDS)
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Daif A, Awada A, al-Rajeh S, Abduljabbar M, al Tahan AR, Obeid T, Malibary T. Cerebral venous thrombosis in adults. A study of 40 cases from Saudi Arabia. Stroke 1995; 26:1193-5. [PMID: 7604412 DOI: 10.1161/01.str.26.7.1193] [Citation(s) in RCA: 155] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE We undertook this study to determine the frequency, clinical patterns, and etiologies of cerebral venous thrombosis in a Middle Eastern country. METHODS Records of all adults patients admitted with an angiographically documented diagnosis of cerebral venous thrombosis from 1985 through 1994 in two major hospitals of Riyadh, Saudi Arabia, were reviewed. RESULTS Forty patients (20 men, 20 women) aged 16 to 40 years were identified. Hospital frequency was 7 per 100,000 patients, and the relative frequency against arterial strokes was 1:62.5. Nineteen cases (47%) had a clinical picture of pseudotumor cerebri. Behçet's disease was the cause in 10 cases (25%). Other causes included antiphospholipid antibodies in 4, protein S deficiency in 3, intracranial tumors in 3, systemic lupus erythematosus in 3, infections in 3, antithrombin III deficiency in 2, postpartum in 1, and oral contraceptives in 1. CONCLUSIONS Cerebral venous thrombosis in adults is not uncommon in Saudi Arabia. Behçet's disease is the single most common etiology. Infection is no longer an important cause, whereas "new" coagulation disorders are common. Patients with a pseudotumor cerebri syndrome should undergo angiography or brain MRI before being labeled idiopathic.
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Affiliation(s)
- A Daif
- Division of Neurology, King Saud University, Riyadh, Saudi Arabia
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32
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Abstract
Fifteen patients aged 11-25 years (mean 15.37, SD 3.89) suffering from juvenile absence epilepsy are presented. Only 3 (20%) had absences (AS) as the only seizure type, 12 (80%) had associated generalized tonic-clinic seizures (GTCS) and in the remaining 3 with absences and GTCS there was also sporadic myoclonus. We found a higher frequency of AS in our patients by clinical history and video-EEG than has been previously reported. In our patients the mean age of onset in years was 11.4, SD 1.24 for AS, 13.12, SD 2.31 for GTCS and 12.5, SD 2.18 for myoclonus. The correct diagnosis was not made on referrals for any of the patients. It took an average of 3-5.5 years from the onset of the AS (range: 6-120 months) and 2 years from the occurrence of GTCS (average: 1-72 months) to make the correct diagnosis and institute proper treatment, which was valproic acid (VPA). The GTCS were controlled in all patients whereas AS continued in 6 (40%), but to a significantly lesser degree. The frequency and the duration of the GTCS before the start of VPA treatment seemed to have an adverse effect on AS control. We documented no circadian rhythm in either AS or the GTCS, except in 2 patients who had AS and GTCS mainly when they awoke in the morning. The sample size was too small to perform a proper genetic study, though a positive history of epilepsies of mixed types was obtained in 35.7% of the parents and the siblings of the probands.
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Affiliation(s)
- T Obeid
- Division of Neurology and Clinical Neurophysiology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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Obeid T, Waheed G. Juvenile myoclonic epilepsy in association with nonprogressive mental subnormality. Ann Saudi Med 1994; 14:264-5. [PMID: 17586908 DOI: 10.5144/0256-4947.1994.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- T Obeid
- Social Insurance Hospital, Riyadh, Saudi Arabia
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Obeid T, el Rab MO, Daif AK, Panayiotopoulos CP, Halim K, Bahakim H, Bamgboye E. Is HLA-DRW13 (W6) associated with juvenile myoclonic epilepsy in Arab patients? Epilepsia 1994; 35:319-21. [PMID: 8156951 DOI: 10.1111/j.1528-1157.1994.tb02437.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In a study of 32 unrelated Arab patients with juvenile myoclonic epilepsy (JME), we compared the frequencies of human leukocyte antigen (HLA) class I and II alleles with those of unrelated healthy controls. A significant difference between the phenotypic frequencies in JME patients and controls was observed for DRW13, the split of DRW6 (37.5 vs 11% of controls). The strength of association as measured by the relative risk was 4.85 for this antigen (p = 0.002). The possible association of JME with HLA-DRW6 recently reported in Caucasians was confirmed in this study. This finding speaks for the homogeneity of the disease among Arabic and Caucasian JME patients. The existence of this association is evidence of a locus in the HLA region that influences expression of JME.
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Affiliation(s)
- T Obeid
- Department of Medicine, College of Medicine, KKUH, King Saud University, Riyadh, Saudi Arabia
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35
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Abstract
We made a long term prospective study of 66 patients with juvenile myoclonic epilepsy (JME). Prevalence was 10.2% among 672 patients with epilepsies. Sex distribution was equal. Sixty-three were not diagnosed on referral; JME was not initially recognized in the epilepsy clinic in 22. Clinical typical absence seizures were reported in 33.3%, myoclonic jerks in 97% and generalized tonic-clonic seizures (GTC) in 78.8% of the patients. Mean age (+/- SD) at onset was 10.5 +/- 3.4 years (range 5-16 years) for absence seizures, 15 +/- 3.5 years (range 8-26 years) for myoclonic jerks, and 16 +/- 3.5 years (9-28) years (range 1-9 years) and GTC by 4.4 +/- 2.7 years (range 1-8 years) in 14 (21.2%) patients who manifested all three types of seizure. Absence were never antedated by myoclonic jerks or GTC. Myoclonic jerks occurred on awakening in 87.5% of the patients. GTC occurred mainly on awakening, but other patients had nocturnal or diurnal GTC with no circadian distribution. Neurologic examination was normal for all patients except for tremor of the hands similar to essential tremor, noted in 35% of patients. Computed tomography (CT) brain scans were normal: 93% of patients had precipitating factors: sleep deprivation (89.5%), fatigue (73.7%), photosensitivity (36.8%; television and video games 8.8%), menstruation (24.1% of women), mental concentration (22.8%), and stress (12.3%). Incidence of JME among siblings (13 of 41 examined families) implies an autosomal recessive mode of inheritance for this Arab population. EEGs were frequently normal in treated patients. At least one abnormal EEG was recorded in 56 (84.9%) patients. Abnormalities consisted mainly of generalized discharges of spike/double spike and/or polyspike and slow wave. Frequent multiple spikes and discharge fragmentations varied from 0.5- to 20-s duration (mean 6.8 s). Twenty (30.3%) had focal abnormalities, and 18 (27.3%) had photoconvulsive discharges. Eighty-eight percent of patients remained seizure-free for > or = 3 years of follow-up. Effective treatment was achieved with valproate (VPA); control of myoclonic jerks was improved with clonazepam (CZP). CZP monotherapy did not consistently prevent GTC. Adding small doses of CZP with simultaneous reduction of VPA was the most effective and better tolerated form of medication, particularly in patients demonstrating an adverse reaction or requiring a large VPA dosage. VPA dosage was successfully reduced in 15 patients who were seizure-free for > 2 years and had infrequent seizures before treatment, but 9 of 11 patients relapsed after VPA discontinuation.(ABSTRACT TRUNCATED AT 400 WORDS)
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Abstract
We present 4 cases of tuberculous meningitis with atypical clinical features and CSF findings. Two patients had initially normal CSF examination, one developed internuclear ophthalmoplegia, while the other had deterioration of consciousness. The third patient presented with paranoid psychosis, and the fourth had a picture mimicking acute bacterial meningitis and he developed right hemianopia due to a tuberculoma detected by MRI. All recovered completely with anti-tuberculous treatment.
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Affiliation(s)
- A Daif
- Division of Neurology, King Khalid University Hospital, Riyadh, Saudi Arabia
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37
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Abstract
Juvenile myoclonic epilepsy (JME), a common form of idiopathic generalized epilepsy, has a distinct clinical and electroencephalographic profile. Often JME is not recognized, with serious consequences on the sufferers. We examined factors contributing to the missed diagnosis even in an epilepsy clinic. Of 70 JME patients, 66 (91.4%) were not diagnosed on referral and 22 (33%) were not initially recognized in the epilepsy clinic. The correct diagnosis was established after a mean of 8.3 +/- 5.5 years from disease onset and an interval of 17.7 +/- 10.4 months from first evaluation in the epilepsy clinic. Myoclonic jerks, the hallmark of the disease, were not usually reported by patients. Similarly, relevant questioning may not be included in the history. Absence seizures antedating jerks by many years, myoclonic jerks reported as unilateral, generalized tonic-clonic seizures occurring during sleep and focal EEG abnormalities are other factors contributing to not recognizing JME. Our study reemphasizes the need to have not only a correct seizure diagnosis but also a correct epilepsy-disease diagnosis.
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Affiliation(s)
- C P Panayiotopoulos
- Division of Neurology, King Khalid University Hospital, Riyadh, Saudi Arabia
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38
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Abstract
The occurrence of photosensitivity (PS) was examined in 327 Arabs greater than or equal to 15 years of age with epilepsy by intermittent photic stimulation (IPS). A control group of 192 nonepileptic Arabs greater than or equal to 15 years of age were also examined by IPS. Of the epileptic patients, 24 (7.3%) were photosensitive, an incidence comparable to that in whites in contradistinction to the reported rarity among African blacks. This finding indicates that environmental factors, particularly excessive sunshine, does not appear to influence the occurrence of PS among epileptic patients. The occurrence of PS among epileptic patients may depend more strongly on the presence of an epileptic syndrome known to have association with PS.
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Affiliation(s)
- T Obeid
- Division of Neurology and Clinical Neurophysiology, King Khalid University Hospital, Riyadh, Saudi Arabia
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39
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Yaqub BA, al-Deeb SM, Daif AK, Sharif HS, Shamena AR, al-Jaberi M, Obeid T, Panayiotopoulos CC. Bickerstaff brainstem encephalitis. A grave non-demyelinating disease with benign prognosis. J Neurol Sci 1990; 96:29-40. [PMID: 2351986 DOI: 10.1016/0022-510x(90)90054-q] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We describe 6 patients with ophthalmoplegia, ataxia and normal or exaggerated deep tendon reflexes. All had been preceded by a febrile illness and had a full recovery without sequelae. The brainstem auditory evoked potentials showed a localised lesion in the upper brainstem while the pattern shift visual evoked potentials were normal and did not show any additional silent lesions. CSF IgG oligoclonal bands were not detected in any of the patients. MRI in 2 patients showed a confluent high intensity lesion in the upper mesencephalon and thalamus involving white and gray matter. Follow-up ranged from 6 to 24 months and showed no relapse.
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Affiliation(s)
- B A Yaqub
- Division of Neurology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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40
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Abstract
We studied the efficacy of clonazepam (CZP) in control of juvenile myoclonic epilepsy (JME) in 17 patients. CZP was very effective in controlling myoclonic jerks in all patients but did not suppress generalized tonic-clonic seizures (GTCS). A disadvantage occurs because the patient is deprived of the warning jerks which presage the onset of GTCS. The circadian rhythm of the GTCS was also changed in two patients.
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Affiliation(s)
- T Obeid
- Division of Neurology and Clinical Neurophysiology, King Khalid University Hospital, Riyadh, Saudi Arabia
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41
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Panayiotopoulos CP, Obeid T, Waheed G. Differentiation of typical absence seizures in epileptic syndromes. A video EEG study of 224 seizures in 20 patients. Brain 1989; 112 ( Pt 4):1039-56. [PMID: 2505885 DOI: 10.1093/brain/112.4.1039] [Citation(s) in RCA: 111] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
This is a comparative video-electroencephalographic (EEG) study of typical absence seizures in 4 epileptic syndromes. In 20 patients, 224 absences were recorded and analysed. Significant clinical and EEG differences were found in the seizure patterns of childhood absence epilepsy (CAE), juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy with absences (JMEA) and myoclonic absence epilepsy (MAE). Clinically, CAE demonstrated more severe impairment of consciousness than JAE while, in JMEA, ictal manifestations were frequently mild and difficult to detect. In the latter, the adolescent patient usually continued his activity, was able to perform even mathematical calculations and often his speech was not disturbed. In children with JMEA, impairment of consciousness was more apparent and sometimes severe. Automatisms occurred in all 4 epileptic syndromes and were proportional to the severity of the demonstrated impairment of consciousness, being rare in JMEA but frequent in CAE and JAE. Expressive speech and overbreathing usually persisted for 1-2 s after the onset of the EEG ictal discharge in CAE. It was less disturbed in JAE where in some absence seizures, interrupted speech and overbreathing were restored during the ictus. A characteristic clinical manifestation of CAE was opening of the eyes in all absence seizures within 1.8 +/- 0.6 s (max. 2.5 s) from the onset of the EEG paroxysms. This early eye-opening behaviour was not observed in JMEA. In MAE, rhythmical myoclonic jerks at 3 Hz make the diagnosis unmistakable. Myoclonic jerks were extremely rare in the absences of JMEA, although all patients had independent myoclonic jerks on awakening. The ictal EEG discharge was longer in JAE (mean 16.3 +/- 7.1 s) than in CAE (12.4 +/- 2.1 s) or JMEA (6.6 +/- 4.2 s). The opening phase of the EEG paroxysms did not show significant differences in CAE, JAE and JMEA but significant changes were found in their initial and terminal ictal phases. In JMEA, the spike-multiple spike-slow wave complexes were not rhythmic and frequently demonstrated variable spike-slow wave relationships. Ictal discharge fragmentations and spike-wave discharges looking like compressed capital Ws were often seen and are characteristic of JMEA. seen and are characteristic of JMEA. Absence seizures demonstrated a more severe impairment of expressive rather than receptive speech, irrespective of differences between syndromes. Evoked as well as spontaneous automatisms occurred in the same patients.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- C P Panayiotopoulos
- Division of Neurology, King Khalid University Hospital, Riyadh, Saudi Arabia
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42
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Abstract
We undertook genetic study of patients with juvenile myoclonic epilepsy (JME) from 17 families. There was a mean of 8 children in each sibship. Siblings were affected in 8 sibships, and some families had more than 2 members affected by JME. Half-siblings and parental involvement were found in only 1 sibship each. The segregation ratio was 0.123 but increased to 0.18 with correction for age of onset. Parental consanguinity was found in 9 (45%) of the sibships. The evidence establishes an autosomal recessive mode of inheritance for JME.
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Affiliation(s)
- C P Panayiotopoulos
- Division of Neurology and Clinical Neurophysiology, King Khalid University Hospital, Riyadh, Saudi Arabia
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43
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Abstract
We report a prospective clinical and electroencephalographic study of 19 patients with juvenile myoclonic epilepsy and absence seizures. Absences began 1 to 9 (4.5 +/- 2.5) years before myoclonic jerks and generalized tonic-clonic seizures. Clinical manifestations during the absence ictus showed great variation, ranging from subtle or no overt features to severe impairment of consciousness, and severity was age related. Simple and complex absence seizures can occur in the same patient. The electroencephalographic features were distinct, with many interictal discharges, fragmentation of the paroxysms, and frequent polyspikes of varying numbers and amplitude for each spike-slow wave component. The combined clinical-electroencephalographic manifestations were characteristic and allow differentiation of absences in juvenile myoclonic epilepsy from typical absence seizures in other epileptic syndromes.
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Affiliation(s)
- C P Panayiotopoulos
- Division of Neurology, King Khalid University Hospital, Riyadh, Saudi Arabia
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44
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Obeid T, Yaqub B, Panayiotopoulos C, al-Jasser S, Shabaan A, Hawass NE. Absence status epilepticus with computed tomographic brain changes following metrizamide myelography. Ann Neurol 1988; 24:582-4. [PMID: 3239959 DOI: 10.1002/ana.410240418] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Absence status epilepticus following metrizamide myelography was associated with computed tomographic scan evidence of a high concentration of the dye in brain gray matter. We suggest that absence status epilepticus is due to the direct effect of metrizamide on the cortex and that this clinically treatable condition may have escaped diagnosis in previous reports.
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Affiliation(s)
- T Obeid
- Department of Neurology, King Khalid University Hospital, Riyadh, Saudi Arabia
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45
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Abstract
Eleven patients with brucellosis presented with neurological features closely simulating transient ischaemic attacks, cerebral infarction, acute confusional state, motor neuron disease, progressive multisystem degeneration, polyradiculoneuropathy, neuralgic amyotrophy, sciatica and cauda equina syndrome. Most patients improved quickly after adequate antibiotic treatment but chronic cases responded poorly. These protean neurological manifestations of brucellosis indicate that the underlying pathological mechanisms are diverse.
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Affiliation(s)
- M Bahemuka
- College of Medicine, Department of Medicine, Riyadh, Saudi Arabia
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46
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Bahemuka M, Babiker MA, Wright SG, Al Orainey I, Obeid T. The pattern of infection of the nervous system in Riyadh: a review of 121 cases. Q J Med 1988; 68:517-24. [PMID: 3252303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Analysis of 121 consecutive cases with infection of the nervous system showed that the majority were the granulomatous infections, tuberculosis and brucellosis (53 cases (44 per cent)). Thirty-nine patients had tuberculosis and 14 had brucellosis. The clinical and microbiological pattern of infection differs from that frequently reported from Western countries. Tuberculosis lesions presented with features of intracranial space occupying lesions (14), spinal cord compression (13) and lumbosacral root compression (1 child). Ten adults and one child had tuberculous meningitis. Pyogenic meningitis present in 38 cases (31 per cent), was most common in children. The infecting organism was identified in 26 patients; Gram-positive cocci in 17, Haemophilus influenzae in four and other Gram-negative organisms in five. Eleven patients had brain abscesses, caused by bacterial infection in eight, fungal infection in two and Toxoplasma gondii in one. Nineteen patients had clinical and pathological features of viral meningitis. Fourteen patients (12 per cent) died including six children with pyogenic meningitis.
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Affiliation(s)
- M Bahemuka
- College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
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47
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Abstract
We studied 50 patients in Saudi Arabia with juvenile myoclonic epilepsy (JME). There was a high positive family history of epilepsy (48.7%) and a high prevalence (10.7%) of other forms of epilepsy. JME was unrecognized at the time of referral for all patients. Age at onset varied from 6 to 28 years with an average of 15.5 years. Treatment was effective with valproate or with clonazepam; 42 patients were seizure-free for a minimum of 6 months of follow-up. EEG abnormalities were recorded in 37 patients; photoconvulsive responses were elicited in 15 patients but only 1 was clinically photosensitive.
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Affiliation(s)
- T Obeid
- Division of Neurology and Clinical Neurophysiology, King Khalid University Hospital, Riyadh, Saudi Arabia
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