Neurology Outpatient Clinic Research Articles

COVID-19 pandemic influence on epilepsy course in pediatric patients

IntroductionIn 2020, Coronavirus Disease 2019 (COVID-19) was declared as a global pandemic. Self-reported stress, anxiety, and insomnia, which are believed to be common triggers for epilepsy, are more likely to occur. We aimed to establish the influence of COVID-19 pandemic itself on changes in the daily life routine related to pandemic on epilepsy course in pediatric patients. The unique form of clinical care which is telemedicine was also taken into consideration. We wanted to evaluate patients' satisfaction with telemedicine and if changing stationary visits into telemedicine influenced epilepsy course in our patients. MethodsPatients, who attended developmental neurology outpatient clinic in the period March–December 2020 were collected. As patients were minors, legal guardians were asked to fill out the questionnaire. Patients were divided according to the outcome into three groups: those with a worsened, stable, or improved course of epilepsy during the pandemic. Appropriate statistical tests for two-group and multi-group comparisons have been implemented. Post hoc p values were also calculated. ResultsFour hundred and two questionnaires were collected. Most of the patients had a stable course of epilepsy during the pandemic; in 13% of participants an improvement has been observed, worsening of the disease was seen in 16% of patients. Age, sex, type of epilepsy, number of seizure incidents before pandemic, and duration of the disease had no statistically significant connection with changes in the course of the disease. Behavioral changes and altered sleep patterns were found to be more common in the worsened group.Fifty-eight percent of patients were satisfied with telemedicine. Poorer satisfaction was connected with less frequent visits, cancellation of scheduled appointments, and lack of help in case of need in an emergency situation. ConclusionEpilepsy course in pediatric patients seems to be stable during COVID-19 pandemic. Sleep disturbances and changes in a child’s behavior may be related to increase in seizure frequency. Telemedicine is an effective tool for supervising children with epilepsy. Patients should be informed about possible ways of getting help in urgent cases.

Predictive Model of Self-management in Patients With Stroke Based on the Information-Motivation-Behavioral Skills Model.

Patients who had a stroke are required to manage risk factors, and self-management for risk factor control in stroke is essential. Recent studies using the information-motivation-behavioral skills model reported that the model is effective for predicting and explaining self-management behavior in chronically ill patients. This study aimed to develop and verify the predictive model of self-management based on the information-motivation-behavioral skills model in patients with stroke. This was a descriptive, cross-sectional study; path analysis was conducted to develop and verify the hypothesized predictive model. We recruited 242 patients who had a stroke using convenience sampling from the neurological outpatient clinic. The model's fit indices were adequate. Stroke self-management knowledge, social support, and self-efficacy had a direct effect on stroke self-management, and stroke self-management knowledge and attitude and social support had an indirect effect on stroke self-management, mediated by self-efficacy. Stroke self-management knowledge and attitude, social support, and self-efficacy explained 27.5% of the total variance in stroke self-management. The information-motivation-behavioral skills model is potentially a predictive model for self-management for patients who had a stroke. Considering the level of stroke knowledge and attitude, social support, and self-efficacy together may help to understand the required level of self-management. In addition, using this model for the development of self-management interventions for patients who had a stroke could be a strategy for improving self-management in patients with stroke.

Comparison of automated office blood pressure measurement with 24-hour ambulatory blood pressure measurement

Purpose Although 24-hour ambulatory blood pressure measurement (24-h ABPM) is the most important method to establish true hypertension, in clinical practice often repeated automated office blood pressure (AOBP) measurements are used because of convenience and lower costs. We aimed to assess the agreement rate between a 30 and 60 min AOBP and 24-h ABPM. Materials and methods Patients with known hypertension (cohort 1) and patients visiting the neurology outpatient clinic after minor stroke or transient ischaemic attack (cohort 2) were selected. We performed AOBP for 30–60 min at 5-min intervals followed by 24-h ABPM and calculated average values of both measurements. Agreement between the two methods was studied with McNemar and Bland–Altman plots with a clinically relevant limit of agreement of ≤10 mm Hg difference in systolic BP. Results Our final cohort consisted of 135 patients from cohort 1 and 72 patients from cohort 2. We found relatively low agreement based on the clinical relevant cut-off value; 64.7% of the measurements were within the limits of agreement for 24-h systolic and 50.2% for 24-h diastolic. This was 61.4% for daytime systolic and 56.6% for daytime diastolic. In 73.5% of the patients, both methods led to the same diagnosis of either being hypertensive or non-hypertensive. This resulted in a significant difference between the methods to determine the diagnosis of hypertension (p < 0.0001). Conclusion We conclude that 30–60 min AOBP measurements cannot replace a 24-h ABPM and propose to perform 24-h ABPM at least on a yearly basis to confirm AOBP measurements.

Factors associated with the longer-term unmet supportive care needs of stroke survivors in Ethiopia: a multicentre cross-sectional study

ObjectivesTo assess the magnitude of the longer-term unmet supportive care needs and associated factors among adult stroke survivors.DesignInstitutional-based multicentre cross-sectional study.SettingBetween 1 March 2020 and 31 May 2020, in Addis...

DOES CHILDHOOD CHOREA MEAN SYDENHAM CHOREA EVERYTIME?

Sydenham Chorea’s is the most common seen movement disorder in childhood age that triggered by Group A Beta-Hemolytic Streptococci. In this article, we were retrospectively examined 39 patients with choreiform movement disorder who were admitted to pediatric neurology and cardiology outpatient clinics. We reviewed these case symptoms, diagnosis period, differential diagnosis and shortening the duration of symptoms with chorea treatment. Two of 39 patients were finally diagnosed Systemic Lupus Erythematosus. In conclusion, although Sydenham Chorea’s is the most common movement disorders, the practitioners should aware of the differential diagnosis. The relapse of Acute Rheumatic Fever with chorea can be prevented by administering antibiotic prophylaxis.

Post Stroke Depression: Experience at Abakaliki Nigeria

Background: Post stroke depression (PSD) is the most common psychiatric complication following stroke. There has not been any study to demonstrate its burden in Abakaliki, Nigeria. It is against this backdrop that we embarked on this study of the frequency and pattern of PSD in Abakaliki Nigeria. Method: This is a cross-sectional observational hospital based study undertaken at the Adult Neurology Outpatient Clinics of Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria from February 2021 to July 2021 (6 months period). Results: Amongst the 110 stroke survivors enrolled in the study, 36 (32.7%) had Post Stroke Depression (PSD) with preponderance of mild type. Female gender and young age were associated with the presence of PSD. Conclusion: Post stroke depression is prevalent amongst stroke survivors in Abakaliki, Nigeria and more preponderant in women and young individuals.

Prevalence of vitamin D insufficiency and deficiency among children with epilepsy

Background and aim The relation between vitamin D, the use of antiepileptic drugs (AEDs), and bone integrity has been found in patients with epilepsy. The aim of the work was to study the prevalence of vitamin D insufficiency and deficiency among children with epilepsy, and to identify some possible risk factors. Patients and methods A comparative cross-sectional study was done on randomly chosen 60 children with epilepsy aged 3–15 years attending the neurology out-patient clinic and 20 healthy age-matched and sex-matched children, attending the pediatric outpatient clinic at Alexandria University Children’s Hospital from September 2014 to March 2015. They were divided into three groups: group I included 40 children receiving AED monotherapy for more than 1 year; group II included newly diagnosed epileptic children before receiving medications; group III included 20 healthy children as controls. History taking included patients’ age, sex, seizure history, nutritional history, sunlight exposure, associated illness or drug intake and history of vitamin D or calcium supplementation. Clinical examinations were done (systematic and neurological examination, weight and BMI). Laboratory investigations [liver and kidney function tests, serum calcium, phosphorus, alkaline phosphatase, and serum 25-hydroxyvitamin D (25(OH)D) levels] were done. Electroencephalogram was done for groups I and II. Results There was no significant difference between all groups regarding age and sex. The BMI was significantly different between groups II and III. Laboratory tests (alanine aminotransferase, aspartate aminotransferase, urea, creatinine, serum calcium, phosphorus, and alkaline phosphatase levels) showed no significant differences between the three studied groups. The mean of 25(OH)D among children in group I was significantly lower compared with children in group III. Females were associated with insufficient and deficient levels of vitamin D. There were statistically significant relations between 25(OH)D levels and BMI and the duration of AED treatment in group I. Conclusion The present study provides evidence of the increased prevalence of vitamin D insufficiency and deficiency among newly diagnosed children with epilepsy and in those on treatment with AEDs. In addition, the study has indicated that female sex, high BMI, AED use (carbamazepine, Na valproate) and prolonged duration of treatment are risk factors for vitamin D insufficiency and deficiency.

THE IMPACT OF COVID-19 INFECTION AND TREATMENT ON MIGRAINE DISABILITY AND PAIN SCORES

Aim: This study aimed to investigate the effects of favipravir used for treating Covid-19 infection and other infectious diseases, on migraine severity and frequency through VAS (Visual Analog Scale), MIDAS (Migraine Disability Assesment Scale). Methods: The study was planned retrospectively, from January 2020 to September 2021, to evaluate patient demographical features who have received migraine diagnosis before or after Covid-19 infection (3 months) admitted in the neurology outpatient clinics of Alanya Alaaddin Keykubat University Training and Research Hospital. Findings: From 70 patients in total 12 (17.1%) of the patients involved in the study were male, while 58 (82.9%) were female. 32 (45.7%) of patients used favipravir and 38 (54.3%) did not use Favipravir. The number of migraine attacks after Covid-19 were found significantly lower than the average of the VAS and Midas scores before covid infection. The average number of migraines before Covid-19 infection was 4.31 ± 2.80, which was found as 3.54 ± 3.07 after the Covid-19 infection. The effect of favipravir use on headache parameters before Covid-19 and after Covid-19 for patients were found similar (p&gt; 0.05). Conclusion: Our study, provides valuable data on the effects of infection and/or isolation on migraine frequency and severity, possibly exerting a prophylactic effect for migraine type headaches.

Clinical and neurophysiological risk factors of learning disabilities in different types of idiopathic focal epilepsy

Objectives Academic difficulties are common in epileptic children. A learning disability (LD) is a reduction in the learning capacity of children or the intellectual ability of adults, which is different from mental retardation or dementia. Materials & Methods The participants were 56 patients, of whom 35 were males (62.5%), and 21 were females (37.5%). The participants attended the Neurology Outpatient Clinic, the Sohag University Hospital, between December 2016 and May 2017. Children with chronological age between 7 and 16 years with idiopathic focal and normal mental and motor developmental history were enrolled in this cross-sectional study. The Revised Quick Neurological Screening Test was used to assess different types of LD. Results LDs were present in 67.9% of our participants with a statistically significant association between LDs in one arm and younger age, earlier age of onset of epilepsy, frequent seizures, and seizure semiology, particularly of temporal lobe origin, in the other arm. In addition, left epileptic focus on EEG, prolonged treatment duration with antiepileptic drugs (AED), and polytherapy were significantly correlated with LDs.Conclusion Many factors are significantly correlated with LDs in children with idiopathic focal epilepsy, like age of the patient, age of epilepsy onset, seizure semiology, prolonged AED treatment, and polytherapy.

Short-Term and Long-Term Effects of Levetiracetam Monotherapy On Hematological Parameters in Children with Idiopathic Epilepsy.

Levetiracetam (LEV) is a broad-spectrum anti-seizure drug (ASD) that has been widely used in recent years. It is thought to have an effect on the release of neurotransmitters that occur as a result of vesicle fusion and exocytosis by binding to synaptic vesicle glycoprotein 2A. The study enrolled patients diagnosed in the Pediatric Neurology Outpatient Clinic who were being followed with the diagnosis of childhood idiopathic epilepsy and were receiving LEV as ASD monotherapy. Sixty-four patients with complete blood count data from the pretreatment (Pre-T) period, the short-term period of 3 to 6 months after treatment (Post-TS), and the long-term period after 12 months (Post-TL) were included in the study. The demographic data of the patients included in the study were retrospectively analyzed for seizure frequency, seizure type, initial and subsequent EEG results, starting date of the treatment, and complete blood count data. Of 64 patients, 36 were male and 28 were female. The mean age of patients was 8.7±3.8 (2.5-16) years. In the whole population, post-TL lymphocyte counts were found to be decreased compared to pre-TL lymphocyte counts. This decrease was statistically significant for patients over 6 years of age (n=46) (p<0.075). In the post-TL period, hematocrit, hemoglobin, mean corpuscular volume, and mean platelet (PLT) volume increased, while white blood cell, PLT, neutrophil, and monocyte counts decreased (p<0.05). Seizure-free status was achieved in 92.2% of cases. Frequent seizures were observed only in five patients who were older than 6 years. Pre-treatment EEG findings were normal for 15 (23.4%) patients, generalized for 8 (12.5%) patients, and focal for 41 (64.1%) patients. According to the pretreatment EEG findings, all of the patients with improvement in EEG were those whose findings were focal (p<0.001). In children with idiopathic epilepsy, long-term LEV monotherapy may cause significant changes in hematological parameters. LEV seems to have effects on the counts and perhaps functions of PLTs, lymphocytes, monocytes, and neutrophils, particularly in the long-term.

Investigation of factors affecting the side of the disease onset in Parkinson’s Disease

Parkinson's disease (PD) is a progressive neurodegenerative disease that starts unilaterally in almost all cases and tends to emerge on the side of the dominant hand, but what we know about the cause of this lateralization is limited. Frequent use of the extremity and physical activity are argued to be protective from PD in preclinical and clinical studies. This study aimed to evaluate the effect of handedness and working in occupations that require continuous use of upper extremities on the disease onset-side. We retrospectively collected 84 PD patients who applied to Koç University Neurology outpatient clinic between July 2016-October 2018. We analyzed the parameters of the side and region of disease onset, age of onset, number of drugs used for PD, hand preference, and patients' occupations. The median age of our study group was 61 (53-69). Thirty (36%) of the 84 patients were women. Seventy-nine patients (94%) were right-handed. Eighty-three (99%) had asymmetric onset. The disease started on the dominant hand side in 47 patients (57%) and on the non-dominant hand side in 36 (43%) patients. In our group with a median disease duration of four (2-7) years, the side with more severe complaints measured with the Unified Parkinson's Disease Evaluation Scale was consistent with the onset-side of the disease (p<0.001). In addition, the number of drugs used for PD and the scale score were higher in patients with longer disease duration (p=0.039, p=0.005). The number of drugs used for PD was also higher in patients with lower extremity-onset or both upper and lower extremities affected simultaneously than the upper extremity-onset (p=0.005). While the probability of starting on the dominant side was 43% in patients working in occupations requiring continuous use of upper extremities, it was 65% in others (p=0.027). According to this study, the onset of PD tends to be on the dominant hand side. Continuous upper extremity use may reduce the possibility of starting on the dominant side.

Translation, cross-cultural adaptation, and validity of the Brazilian version of the Cognitive Function Instrument.

ABSTRACT.Subjective cognitive decline (SCD) is defined as a self-perception of a progressive cognitive impairment, which is not detected objectively through neuropsychological tests. The Alzheimer's Disease Cooperative Study developed the Cognitive Function Instrument (CFI) to evaluate individuals with SCD. The CFI consists of two versions, namely, a self-report and a partner report.Objective:This study aimed to translate CFI into Brazilian Portuguese, perform a cross-cultural adaptation, and validate the Brazilian version.Methods:The translation and transcultural adaptation process consisted of six stages, and the preliminary version was answered by a sample of individuals recruited among the patients’ caregivers from a cognitive neurology outpatient clinic. Finally, the final Brazilian version of the CFI was applied to a sample of nondemented older adults to validate the instrument, which was divided into with and without SCD, according to the answer “yes” for the question: “Do you feel like your memory is becoming worse?”.Results:The final version of CFI showed a high level of acceptability as an assessment tool in nondemented older adults. Participants with SCD had higher scores in the CFI self-report compared with those without complaints. In the receiver operating characteristic curve analysis, the area under the curve of the CFI self-report was 0.865 (95% confidence interval 0.779–0.951), and the cutoff score of 2.0 was the one that best distinguished the SCD group from the control group, with a sensitivity of 73.3% and a specificity of 81.5%.Conclusions:CFI proved to be an instrument with good accuracy and easy applicability to identify older adults with SCD.

ÇOCUKLUK ÇAĞINDA VERTİGO: BAŞ DÖNMESİ OLAN ÇOCUKLARI NASIL DEĞERLENDİRELİM?

Objective&#x0D; Vertigo is a complaint consisting of wide spectrum&#x0D; of diagnoses in childhood. The aim of this study was&#x0D; to evaluate clinical characteristics and differential&#x0D; diagnosis of pediatric patients with vertigo.&#x0D; Material and Methods&#x0D; In this retrospective study, the medical records of&#x0D; a hundred patients who presented to the Pediatric&#x0D; Neurology Outpatient clinic with the complaint of&#x0D; vertigo between January 2018-January 2021 were&#x0D; reviewed. Patients were evaluated for age, gender,&#x0D; family history, duration of symptoms, frequency of&#x0D; attacks, provoking factors, accompanying symptoms,&#x0D; physical examination, laboratory findings and final&#x0D; diagnosis.&#x0D; Results&#x0D; The mean age was 12.39 years. The majority of the&#x0D; patients were males (64%). There were different&#x0D; causes of vertigo, but the most common two were&#x0D; infection (34%) and psychogenic vertigo (25%). The&#x0D; other frequent reasons were orthostatic hypotension&#x0D; (16%) and vitamin B12 deficiency (9%). Most of the&#x0D; patients had symptom duration for less than one&#x0D; month (46%), and the attacks were primarily seen&#x0D; (65%) every day. Patients explained their attacks as&#x0D; the motion of the surrounding (61%), spinning (27%),&#x0D; imbalance (20%), and others. The most common&#x0D; accompanying symptoms were fatigue (60%) and&#x0D; headache (54%). Laboratory data revealed vitamin&#x0D; B12 deficiency in nine patients; all other tests were&#x0D; in the normal range. Thirty-nine patients had cranial&#x0D; MRI, only 2 of them revealed abnormal findings, one&#x0D; of them was responsible for vertigo.&#x0D; Conclusion&#x0D; Vertigo in children creates a profound sense of&#x0D; anxiety both in parents and physicians leading to&#x0D; excessive number of functional testing and imaging&#x0D; examinations. Evaluation should begin with detailed&#x0D; history and comprehensive physical evaluation to&#x0D; avoid superfluous testing and diagnostics. Serious&#x0D; cases are fortunately rare and can be detected by&#x0D; careful clinical examination.

Psychiatric morbidity among informal caregivers of children suffering from intellectual developmental disorders.

To assess the presence of psychiatric morbidity and associated socio-demographic factors among informal caregivers of children suffering from intellectual developmental disorders. The analytical cross-sectional study was conducted at the Neurology Department of a tertiary care hospital in Rawalpindi, Pakistan, from January 1, 2018, to December 31, 2019, and comprised informal caregiver of children diagnosed with intellectual developmental disorders presenting at the paediatric or neurology outpatient clinics of the hospital. Intellectual developmental disorder was diagnosed by consultant neurologists or psychiatrists or paediatricians on the basis of International Classification of Diseases-11 criteria. Psychiatric morbidity in the informal caregiver was assessed using the 12-item general health questionnaire. Data was analysed using SPSS 23, and binary logistic regression was applied to assess association. Of the 500 informal caregivers, 323(64.6%) showed psychiatric morbidity. Increasing age and comorbid epilepsy among the patients were significantly related to the presence of psychiatric morbidity among the informal caregivers (p<0.05). Majority of informal caregivers of children with learning difficulties were found to have psychiatric morbidity.

Prevalence study of multiple sclerosis in the Spanish province of Zamora

IntroductionWe conducted a prevalence study of multiple sclerosis (MS) in the Spanish province of Zamora. MethodsWe conducted a retrospective cohort study of data on patients with multiple sclerosis under follow-up at the neurology outpatient clinic at Hospital de Zamora as of 6 June 2021. We studied demographic (sex, age) and clinical variables (form of disease, duration, expanded disability status scale [EDSS] score, progression index [EDSS/years duration], and treatment). ResultsAs of 6 June 2021, the prevalence of MS was 98.8 cases/100000 population (95% confidence interval [CI], 91.3–106.3), and the mean incidence for the last 10 years was 3.5 cases/100000 person-years (95% CI, 2.1–4.9). The age-standardised prevalence (calculated using the 2013 European Standard Population) was 102.4 (95% CI, 83.5–121.3), and incidence was 4.6 (95% CI, 0.5–8.7).Out of the 168 patients in our cohort, 119 (70.8%) were women. The mean age (standard deviation) in our sample was 46.5 (13.1) (95% CI, 45.5–47.5) years, and the mean disease duration was 12.6 (9.0) (95% CI, 11.8–13.4) years, with a median EDSS score of 2.0 (range, 0–8.5). A total of 129 (78.7%) patients were receiving treatment, of which 84 (51.2%) were receiving a moderate-efficacy drug and 42 (25.6%) were receiving a high-efficacy drug. Among patients not receiving treatment, this was mostly due to their personal decision, long disease duration, and/or clinical stability. ConclusionsThe prevalence of multiple sclerosis in the Spanish province of Zamora is intermediate-high and is in line with the mean for Spain.

Jeneralize Tonik Klonik Tip Epilepsi Tanısı Konulan, Monoterapi ve Politerapi Olarak Antiepileptik Tedavi Alan Hastalarda Akut Faz Reaktanları ve Oksidan-Antioksidan Parametrelerin Araştırılması

Objective: This study aimed to investigate the relationship between acute-phase reactants and oxidative stress and epilepsy.&#x0D; Methods: The patient group consisted of 67 patients who applied to the Pediatric Neurology outpatient clinic and were diagnosed with generalized type epilepsy according to ILAE classification, 33 were receiving monotherapy and 34 were receiving antiepileptic medication in the form of polytherapy. The control group included 30 healthy volunteer participants with similar sociodemographic characteristics in the same age range, without epilepsy or any known chronic disease. Total anti-Oxidant Status (TAS) and total Oxidant Status (TOS) were measured according to the method developed by Erel, and the oxidative stress index (OSI) was calculated. Sensitive C-reactive protein (Hs-CRP) levels were measured.&#x0D; Results: Both TOS and OSI levels of the patients who received antiepileptic monotherapy and polytherapy were statistically significantly higher than the control group (p = 0.004, the TOS levels of the patients who received antiepileptic monotherapy and polytherapy were 19.29 ± 1.27, 19.22 ± 1.26, respectively, control group 14.49 ± 1.75, OSI levels of patients receiving antiepileptic monotherapy and polytherapy 1.66 ± 0.12, 1.72 ± 0.11, control group 1.27 ± 0.11), respectively. The Hs-CRP level (0.59 ± 0.06 mg / L, 1.09 ± 0.06 mg / L, respectively) of the patients who received monotherapy and polytherapy was statistically significant compared to the control group (0.42 ± 0.02 mg / L) significantly higher.&#x0D; Conclusion: In this study, the findings suggest that epileptic seizures increase oxidative stress parameters and antioxidant mechanisms are insufficient to reduce oxidative damage. In addition, considering the high serum Hs-CRP levels, it is extremely important to develop treatment strategies that can control the inflammatory process in treating resistant epilepsy.

Development and Evaluation of Treatment Adherence Interventions for Older Adults With MCI Using IoT Devices

For older adults with mild cognitive impairment (MCI), treatment adherence is essential to prevent and delay dementia. Older adults with MCI should maintain treatment for chronic diseases, exercise regularly, and adhere to treatment to maintain health status. There is a lack of comprehensive interventions to promote treatment adherence (medication adherence and physical activity) for older adults with MCI. The purpose of this study was to develop an internet of things (IoT)-based real-time treatment adherence for old adults with MCI and examine the effectiveness of the program. This study was a randomized controlled trial. The patients were enrolled from the neurology outpatient department clinic at a hospital in Korea. The subjects were 18 in the experimental group and 20 in the control group. This study intervention was IoT-based medication adherence device and real-time monitoring sever plus wrist wearable device. The study consists of a 10-week intervention period. The intervention program was provided for only the experimental group and the control group with a wearable device and usual care. Assessments were conducted at baseline, 6 weeks, and 10-weeks. A mixed-effects model was used in the analysis to evaluate the program. The IoT-based treatment adherence intervention was effective in improving medication adherence over time (β =11.465, p<.001), physical activity (K-PASE) (β =27.376, p<.001) and average the number of steps per week (β=3202.53, p<.001). Health care providers can use this program to improve treatment adherence for chronic disease management and dementia prevention of older adults with cognitive impairment.

The Risk Factors Affecting Disability Level of Lumbar Disc Herniation

Background. Lumbar disc herniation (LDH) is a disorder that involves rupture of the annulus fibrosus so that the nucleus pulposus protrudes and compresses the lumbar canal. LDH is the most common cause of lumbar radiculopathy. LDH causes functional disorders in patients, causing disability to carry out daily activities. The purpose of this study was to determine the risk factors that influence the degree of disability in lumbar nucleus pulposus herniation.&#x0D; Methods. Analytical research with a consecutive cross-sectional study approach in patients with lumbar LDH at the Neurology Outpatient Clinic, Dr. M. Djamil General Hospital Padang from March to November 2021. The risk factors assessed were age, gender, occupation, length of illness, and body mass index (BMI). The measurement of the degree of disability uses the Oswestry disability index (ODI) score. The relationship between risk factors and the degree of disability was analyzed using chi-square test. Differences in the mean age of groups with mild and moderate degrees of disability using unpaired t-test.&#x0D; Results. 40 subjects met the inclusion and exclusion criteria. Mean age 57 ± 10,976 years, male and female ratio 1:2, work with heavy lifting activities was found in 70% of subjects, duration of suffering from LDH more than one year in 60% of subjects. BMI overweight and obesity as many as 77.5% subjects. As many as 60% of the subjects experienced mild to moderate degrees of disability. There is a difference in the average age of the subjects with mild to moderate degree of disability with a severe degree of p-value of 0.044. There was no significant relationship between gender (p=0.054), occupation (p=0.398), length of illness (p=0.503) and body mass index (p=0.757), and the degree of disability.&#x0D; Conclusion. The degree of disability in patients with LDH is influenced by age. Meanwhile, gender, occupation, length of illness and body mass index were not significantly related to the degree of disability in patients.

Effects of epilepsy education on the academic achievement and quality of life of children with epilepsy

Background: Epilepsy can have a huge impact on children's quality of life and participation and attainment at school, particularly if the condition is poorly managed. Aims: The aim of this study is to investigate the effect of education about disease and drug management given to children, their family and teachers on the academic success and quality of life of the child. Design: The study was a single group, pre-test, post-test, semi-experimental research study. Methods: The study was carried out in the paediatric neurology outpatient clinic of the Tepecik Education and Research Hospital in Turkey. The study sample comprised 65 people (25 patients, 25 parents and 15 teachers) who completed the pre-test and post-test assessments. The Sociodemographic Characteristics Questionnaire, the Quality of Life Scale in Children with Epilepsy and an academic achievement form were completed before the epilepsy education was given. Parents and children had training at the hospital. The teachers had telephone training. Some 3 months after the training, the scores for the Quality of Life Scale in Children with Epilepsy and the academic achievement form were reassessed. Findings: The comparison of the pre- and post-training Quality of Life scale scores of the children (p=0.000) and academic achievement scores of the children (p=0.017; n=15) demonstrated a significant increase. There was a significant difference between the quality of life scores of the participating children who received special education and those of the children who did not receive special education (p=0.007 and p=0.004, respectively). Conclusions: The results of the present study suggest that providing training on epilepsy, not only for children but also for their families and teachers, would be beneficial.

Establishing a relationship between semantic clustering and language performance

AbstractBackgroundSemantic clustering (SC) is an implicit learning strategy commonly utilized on verbal list‐learning tasks. While research has examined SC and executive functioning and memory, little has been done relating SC and language. In the present study, we calculated a SC score on a common list‐learning task and explored relationships with language performance. We predicted weaker SC in individuals with MCI compared cognitively normal individuals, which could potentially be used as an additional measure to help identify MCI and Alzheimer’s disease.MethodArchival test data from an outpatient neurology clinic were extracted (N=355), including the Hopkins Verbal Learning Test – Revised, Boston Naming Test, WAIS‐IV Similarities, D‐KEFS Verbal Fluency Letter Fluency (FAS) and Category Fluency (CF) tests, and Wide Range Achievement Test‐Reading (WRAT). Diagnostic subgroups of MCI and CN were created using actuarial diagnostic criteria. SC was calculated as the sum of novel consecutive recalls belonging to the same category, without repeats or semantically‐related intrusions. A chi‐square test was conducted to assess differences between demographic factors. ANCOVA was used to compare performance of SC and selected language measures between the MCI and CN groups using age and WRAT‐Reading as covariates; SC and language measure raw scores were treated as dependent variables and diagnostic grouping as the independent variable.ResultDifferences in age(X2 =36.39,p&lt;0.01), education(X2 =21.44,p&lt;0.05), and WRAT‐Reading SS(X2 =45.43,p&lt;0.01) were found. ANOVA found significant differences between the groups’ SC scores, as well as performance on language measures (p&lt;0.05). The CN group showed a trend of being stronger than the MCI group across all measures, including SC. Generally, language measures were significantly positively correlated with SC scores for both groups (p&lt;0.05), including BNT and CF, and FAS for the CN group.ConclusionOverall, findings support our hypothesis that both SC and language scores vary as a function of clinical diagnosis with the CN group having stronger abilities than those with MCI. As such, SC scores derived from verbal learning tests may be able to contribute to knowledge of one’s language skills. Further research should aim to help establish this relationship. SC scores could assist in screening for MCI or cognitive deficiencies resulting from AD.