Neurology Outpatient Clinic Research Articles

Helicobacter pylori Infection in Children With Cerebral Palsy: A Cross-Sectional Study

BackgroundChildren with cerebral palsy (CP) frequently have associated disorders and complications, including gastrointestinal problems. Helicobacter pylori is a common infection worldwide, frequently associated with gastrointestinal manifestations. MethodsTo estimate the prevalence of H. pylori infection in children with CP, a cross-sectional study over an eight-month period was performed in the pediatric neurology outpatient clinic of Tanta University Hospital. The study included 100 patients with CP aged two to 17 years. All patients were tested for H. pylori antigen in stool by enzyme-linked immunosorbent assay. ResultsThe mean age of studied children with CP was 7.03 ± 4.1 years; there were 57 males and 43 females. Spastic quadriplegic CP was the most common type of CP (34%). Forty-five children with CP were positive for H. pylori antigen in stool. Intellectual disability (ID), low sociodemographic scoring system, semisolid diet, and Eating and Drinking Ability Classification System (EDACS) levels 4 and 5 were significant predictors of H. pylori infection (odds ratio of 1.86, 2.63, 12, and 1.77, respectively, P < 0.05). Vomiting, abdominal pain, and gastrointestinal tract bleeding were significantly more frequent in H. pylori-infected children with CP than noninfected children with CP (P value < 0.05) ConclusionH. pylori is a relatively common infection among children with CP. The main risk factors for H. pylori infection were low socioeconomic level, ID, semisolid diet, and EDACS levels 4 and 5.

Evaluation of Peripheral Inflammatory Activity in Different Types of Dementia

Aim: Alzheimer's disease (AD) is a chronic neurodegenerative disease characterized by pathophysiological processes involving neuroinflammation, neurodegeneration, and synaptic dysfunction. Vascular dementia (VaD) stands as the second most prevalent form among all dementia types, sharing common pathophysiological mechanisms with AD, such as vascular oxidative stress and chronic inflammation.The neutrophil-to-lymphocyte ratio (NLR) is considered a simple, noninvasive, and widely available clinical marker of inflammation. The aim of this study is to investigate the potential differences between these two different types of dementia in terms of NLR values. Materials and Methods:The data of patients diagnosed with AD or VaD and healthy controls who applied to a University Hospital Neurology outpatient clinic were retrospectively examined, and the groups were analyzed with statistical methods in terms of NLR levels. Results: A total of 39 AD, 32 VaD, and 30 healthy controls were enrolled in the study. Hemogram analyses revealed significantly elevated NLR values in both the AD and VaD groups compared to the healthy control group (p = .001, p = .001, respectively). AD and VaD groups demonstrated no significant difference in NLR (p = .787).Additionally, as a result of regression analyses, it was determined that age and NLR were independent variables associated with the presence of dementia. Conclusions:NLR values are at higher levels in AD and VaD patient groups compared to healthy controls. Our results support the role of peripheral inflammation in the pathogenesis of VaD, as in AD. Additional studies are needed on potential inflammatory biomarkers of VaD.

The Interrelationship of Benefit Finding, Demoralization, and Stigma among Patients with Parkinson's Disease and Their Caregivers.

Parkinson's disease (PD) is a debilitating neurodegenerative disease with a relentlessly progressive course of illness. This study aimed to assess the dyadic dynamics of benefit finding (BF), demoralization, and stigma on the depression severity of PD patients and their caregivers. This study used a cross-sectional design with purposive sampling. In total, 120 PD patients and 120 caregivers were recruited from the neurological ward or neurological outpatient clinic of a medical center in Taiwan from October 2021 to September 2022. PD patients and their caregivers were enrolled and assessed using the Mini International Neuropsychiatric Interview, the Benefit Finding scale, Demoralization Scale, Stigma Subscale of the Explanatory Model Interview Catalogue, and Taiwanese Depression Questionnaire. Among the 120 patients and 120 caregivers that successfully completed the study, 41.7% (N = 50) and 60% (N = 72) were female, respectively. The most common psychiatric diagnoses of both the PD patients (17.5%) and their caregivers (13.3%) were depressive disorders. Using structural equation modeling, we found that the stigma, BF, and demoralization of PD patients might contribute to their depression severity. Demoralization and stigma of PD patients' caregivers might also contribute to the depression severity of PD patients. Caregivers' BF and demoralization were significantly linked with their depression severity. PD patients' BF degree and their caregivers' BF degree had significant interactive effects. Both patients' and their caregivers' stigma levels had significant interactive effects. Clinicians should be aware of and manage these contributing factors between PD patients and their caregivers in order to prevent them from exacerbating each other's depression.

Effect of physical frailty on maximum phonation time in community-dwelling older individuals who visited a neurology outpatient clinic.

Maximum phonation time (MPT) is used to assess speech and other oral rehabilitation-related issues. Various factors contribute to MPT decline in older individuals. Although the impact of physical frailty on MPT has been suggested, this has not been conclusively determined. To examine the relationship between MPT and physical frailty in community-dwelling individuals aged ≥60 years who were independently mobile. MPT-associated factors were investigated. This cross-sectional study analysed the clinical data of 122 patients (age [interquartile range]: 80.0 [74.0-83.0] years) without dementia who visited a neurology department between 1 February 2021 and 31 January 2023. Investigated factors included age, sex, weight, height, body mass index, smoking history, grip strength, functional independence measure, vital capacity, oral diadochokinesis, MPT and the Japanese Cardiovascular Health Study score. Physical frailty was assessed based on the total score from five items (weight loss, weakness, exhaustion, slowness and low physical activity). The relationship between MPT and physical frailty was examined using Spearman's rank correlation coefficient and hierarchical multiple regression analysis. The MPT was negatively correlated with age (r = -0.347, p < .01) and physical frailty (r = -0.681, p < .01) and positively correlated with vital capacity (r = 0.474, p < .01) and height (r = 0.248, p < .01). The hierarchical multiple regression analysis, conducted with MPT as the dependent variable, demonstrated that physical frailty (β = -.59, 95% confidence interval: -0.74 to 0.43, p < .001) had a strong influence on MPT. In older individuals, MPT is associated with physical frailty. When assessing MPT in clinical settings, it is advisable to perform a concurrent assessment of physical frailty.

Understanding Trainee and Patient Behaviors to Enhance Medication Reconciliation Processes in the Outpatient Neurology Clinic: A Quality Improvement Initiative (P7-4.006)

Understanding Trainee and Patient Behaviors to Enhance Medication Reconciliation Processes in the Outpatient Neurology Clinic: A Quality Improvement Initiative (P7-4.006)

Smoking Prevalence and Smoking Cessation Treatment Rates Across the Neurology Outpatient Clinics at a Large Academic Hospital (P2-10.004)

Smoking Prevalence and Smoking Cessation Treatment Rates Across the Neurology Outpatient Clinics at a Large Academic Hospital (P2-10.004)

Impact of SARS-CoV-2 Infection and Vaccination on Migraine Symptoms during the COVID-19 Pandemic

Introduction: Studies have shown the worsening of migraine associated with the COVID-19 infection and the pandemic more broadly. COVID-19 vaccination has also been associated with symptomatic headache, with high frequency among migraineurs. We aimed to assess the impact of COVID-19 diagnosis and vaccine administration on migraine, during the SARS-CoV-2 pandemic. Methods: An online questionnaire was sent to migraine patients followed in a neurology outpatient clinic between March and November 2022. The survey inquired about migraine symptoms and treatment changes, as well as sleep changes, anxiety, and depressive symptoms during the pandemic, after a COVID-19 diagnosis and/or vaccination. Results: Out of the 185 patients included, 108 (58.4%) reported a change in headache pattern (intensity, frequency, and/or pain quality) and 47% reported higher intensity and frequency. The pattern changes occurred before the COVID-19 diagnosis in 41%. Of all the participants with headache changes 72.2% needed to intensify medication (abortive or prophylaxis), regardless of infection status. High levels of insomnia, anxiety, and depressive symptoms were found among patients with worsening migraine, irrespective of COVID-19 diagnosis. After vaccination, 49 (27.1%) described a change in headache pattern, with a worsening pattern in 29 (16%). In half, this change occurred for up to 3 weeks. Conclusion: Worsening of migraine was more likely associated with other factors related to the pandemic rather than COVID-19 diagnosis. COVID-19 vaccination might have acted as an additional but less relevant and temporary trigger for migraine worsening.

Smith-Magenis Syndrome associated with Autism Spectrum Disorder with delayed diagnosis due to B12 deficiency: a case report

IntroductionSmith-Magenis syndrome (SMS) is a complex genetic disorder characterised by distinctive physical features, developmental delay, cognitive impairment and a typical behavioural phenotype. SMS is caused by interstitial 17p11.2 deletions (90%) involving multiple genes, including the retinoic acid-induced 1 gene (RAI1), or by pathogenic variants in RAI1 itself (10%).ObjectivesIn this case report, we present a case of Smith-Magenis syndrome with Autism Spectrum Disorder with karyotype 46,XX, 17p 11.2 gene deletion confirmed by Autism Spectrum Disorder, who was followed up in a paediatric neurology outpatient clinic with neuromotor developmental delay and whose diagnosis was delayed due to B12 deficiency. We also update scientific developments in Smith-Magenis syndrome.MethodsWe describe an 18-month-old male with Smith-Magenis syndrome and Autism Spectrum Disorder who was seen in our paediatric psychiatric outpatient clinic and who received B12 replacement with developmental delay.ResultsThe patient was followed up in the paediatric neurology outpatient clinic with delay in neuromotor developmental milestones and this delay was thought to be due to B12 deficiency (B12&lt;100 ng/L). The initial examination revealed delay in neuromotor and behavioural milestones, speech delay, wide and high nasal bridge and hypertelorism. Further physical examination revealed syndactyly of the second and third toes bilaterally and crossed lower teeth. Clinical and psychometric testing (Ankara Developmental Screening Inventory) by 2 consultants and 1 research assistant resulted in a diagnosis of intellectual disability and an additional diagnosis of Autism Spectrum Disorder due to social deficits that could not be explained by intellectual disability.ConclusionsSmith-Magenis syndrome is a well-known disorder involving the deletion of chromosome 17p11.2, which contains the RAI1 gene. This condition is associated with neuromotor and behavioural delay, as well as distinctive dysmorphic features. Clinicians should consider Smith-Magenis syndrome in the differential diagnosis for patients with delayed neuromotor and behavioural milestones, even in the presence of documented blood parameters (such as B12 deficiency) that may account for the delay.Disclosure of InterestNone Declared

AN UNCOMMON PRESENTATION OF SEPTUM PELLUCIDUM ANATOMICAL VARIATIONS: A CASE REPORT OF GENERALIZED TONIC-CLONIC SEIZURE IN A HEALTHY ADULT

ABSTRACT:&#x0D; Introduction: The septum pellucidum (SP) is a thin, transparent, dual-membrane structure located between the lateral ventricles of the brain. Incidentally identified through imaging modalities, this variation, while rare, may manifest with symptoms such as neuropsychiatric disorders, headache, dizziness, seizures, nausea, and vomiting. In this report, we present the case of a healthy middle-aged man with CV and CSP, who sought medical attention in the emergency department (ED) due to a generalized tonic-clonic seizure (GTCS).&#x0D; Case Report: A 40-year-old male without any known medical history presented to our emergency department with a GTCS. Considering this as the first seizure, blood and imaging tests were conducted, all of which showed no abnormalities. Non-contrast computed tomography revealed sequel cystic encephalomalacic areas in the left occipital and right frontal cerebral hemispheres, consistent with a parapharyngeal epidermoid cyst, and the presence of cavum septum pellucidum et vergae. Emergency consultation from the neurological clinic was sought, and an electroencephalogram showed no seizure activity. He was subsequently discharged with a recommendation for follow-up at the neurology outpatient clinic.&#x0D; Conclusion: This case prompts critical considerations in the emergency medicine realm regarding the potential relationship between anatomical variations in the septum pellucidum and emergent seizure activity.&#x0D; Keywords: Septum pellucidum, seizure, cavum vargae, emergency

The effects of web-based animation-supported progressive relaxation exercises applied to individuals with epilepsy on fatigue and sleep quality: A randomized controlled study

PurposeThe study was conducted to determine the effects of Progressive Relaxation Exercise, supported by mobile-based animation, on fatigue and sleep quality of individuals with epilepsy. Material-MethodThe study was conducted in a randomized controlled design with a pretest-posttest model on epileptic individuals who applied to Giresun University, Faculty of Medicine, Neurology Outpatient Clinic between February and December 2022. By using power analysis, the sample of the study was determined as 60 epilepsy patients (30 in the Control Group, 30 in the Experimental Group). The data were collected by face-to-face interview technique with the Personal Information Form, Pittsburgh Sleep Quality Index (PSQI), and Fatigue Severity Scale (FSS). Frequencies, percentages, arithmetic mean, standard deviations, Pearson Correlation Analysis, Paired t-Test, Student’s t-Test, and Chi-Square Test were used in the evaluation of the study data. ResultsWhen the Control Group’s mean scores in the pre-test and post-tests, which were performed with an interval of 6 weeks, were compared, a statistically significant difference was detected between the FSS and PSQI scores (p>0.05). The mean Fatigue Severity Scale score was found to be 5.24 ± 0.69 before the Progressive Relaxation Exercises and 3.82 ± 0.77 after the exercises. The mean scores of the individuals on the Fatigue Severity Scale after the relaxation exercises were found to be lower at a statistically significant level than the mean scores before the relaxation exercises (p<0.001). The differences between subjective sleep quality (p<0.001), sleep latency (p<0.001), daytime dysfunction (p<0.001), and total sleep quality (p<0.001) score averages after the Progressive Relaxation Exercises were statistically significant compared to the pre-exercises status. When the post-test scores of the participants in the Experimental Group was examined, significant, moderate, and positive differences were detected between the FSS and Total PSQI scores (r: 0.373-p: 0.042), Subjective Sleep Quality (r: 0.487-p: 0.006), which is one of the sub-dimensions of PSQI, Sleeping Pill Use (r: 0.531-p: 0.003), and Daytime Dysfunction (r: 0.461-p: 0.01) scores. ConclusionIt was determined that individuals with epilepsy experience fatigue and deterioration in sleep quality and there is a reciprocal relationship between the severity of fatigue and sleep quality in these individuals. Progressive Relaxation Exercises applied with the animation-supported web-based mobile intervention technique reduce the fatigue levels of individuals and increase sleep quality.

Disparities in Genetic Testing for Neurologic Disorders.

Genetic testing is now the standard of care for many neurologic conditions. Health care disparities are unfortunately widespread in the US health care system, but disparities in the utilization of genetic testing for neurologic conditions have not been studied. We tested the hypothesis that access to and results of genetic testing vary according to race, ethnicity, sex, socioeconomic status, and insurance status for adults with neurologic conditions. We analyzed retrospective data from patients who underwent genetic evaluation and testing through our institution's neurogenetics program. We tested for differences between demographic groups in 3 steps of a genetic evaluation pathway: (1) attending a neurogenetic evaluation, (2) completing genetic testing, and (3) receiving a diagnostic result. We compared patients on this genetic evaluation pathway with the population of all neurology outpatients at our institution, using univariate and multivariable logistic regression analyses. Between 2015 and 2022, a total of 128,440 patients were seen in our outpatient neurology clinics and 2,540 patients underwent genetic evaluation. Black patients were less than half as likely as White patients to be evaluated (odds ratio [OR] 0.49, p < 0.001), and this disparity was similar after controlling for other demographic factors in multivariable analysis. Patients from the least wealthy quartile of zip codes were also less likely to be evaluated (OR 0.67, p < 0.001). Among patients who underwent evaluation, there were no disparities in the likelihood of completing genetic testing, nor in the likelihood of a diagnostic result after adjusting for age. Analyses restricted to specific indications for genetic testing supported these findings. We observed unequal utilization of our clinical neurogenetics program for patients from marginalized and minoritized demographic groups, especially Black patients. Among patients who do undergo evaluation, all groups benefit similarly from genetic testing when it is indicated. Understanding and removing barriers to accessing genetic testing will be essential to health care equity and optimal care for all patients with neurologic disorders.

A comprehensive look at inflammation in RLS: assessing NLR, MLR, PLR, SII, SIRI, and microR

Aims: Restless legs syndrome (RLS) has been linked to systemic inflammation. The number of studies investigating inflammation in RLS patients is extremely limited. The purpose of this study is to examine the possible role of proinflammatory parameters in RLS, specifically neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and microR.&#x0D; Methods: The study included 100 patients admitted to the neurology outpatient clinic diagnosed with RLS using the International Restless Legs Syndrome Study Group ((IRLSSG) scale and 100 healthy controls. Hemogram results were obtained from both RLS patients and healthy controls, while ferritin, folate, vitamin D and B12, and C-reactive protein (CRP) levels were obtained only from RLS patients.&#x0D; Results: The median age of the patient group was 52.50 (43-60.75), while the median age of the healthy group was 51.00 (50-53). The patient group is 37% male, while the healthy group is 34% male. It doesn't vary by age or gender (p=0.658). The two groups showed significant differences in PLR (

Adherence to Epilepsy's Medical Recommendations.

The primary problem in the treatment of epilepsy is poor seizure control. Several studies have shown that non-adherence to doctors' recommendations regarding drug dosage, time of drug administration as well as lifestyle modifications are the most frequent causes of the persistence or reoccurrence of seizures, other than cases of misdiagnosis and poor drug selection. The aim of this study was to assess the prevalence of non-compliance with medical recommendations, both in relation to medicine dosage, regularity of administration and lifestyle, and also to determine the factors affecting patients with diagnosed epilepsy. This study was carried out on a total of 169 patients diagnosed with epilepsy who were under the care of an outpatient neurology clinic. The assessment of compliance was performed using the Patient Rating of Compliance Scale (PRCS), Clinician Rating Scale (CRS) and authors' scale. Depending on the scale used, varying degrees of non-compliance were noted. They were as follows-65.3% on the authors' scale, 10% on the PRCS and 9% on the CRS. The following factors influenced compliance with doctors' recommendations: type of epilepsy, consumption of alcoholic beverages, frequency of follow-up visits to the neurology clinic, type of pharmacotherapy and number of medicines taken.

Cognitive decline in post-COVID-19 syndrome does not correspond with persisting neuronal or astrocytic damage

Cognitive impairment is the most frequent symptom reported in post-COVID-19 syndrome (PCS). Aetiology of cognitive impairment in PCS is still to be determined. Neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) are increased in acute COVID-19. Their role as biomarkers in other neurological disorders is under debate. We analysed serum levels of NfL and GFAP as markers for neuronal and astrocytic damage in 53 patients presenting to a PCS Neurology outpatient clinic. Only individuals with self-reported cognitive complaints were included. In these individuals, cognitive complaints were further assessed by comprehensive neuropsychological assessment (NPA). Patients were categorized into subgroups of subjective cognitive decline, single domain impairment, or multi-domain impairment. Serum NfL was in normal range, however an increase of serum GFAP was detected in 4% of patients. Serum NfL and GFAP levels correlated with each other, even when adjusting for patient age (r = 0.347, p = 0.012). NPA showed deficits in 70%; 40% showing impairment in several tested domains. No significant differences were found between serum NfL- and GFAP-levels comparing patients with subjective cognitive decline, single domain impairment, or multi-domain impairment. Persistent neuronal or astrocytic damage did not correlate with cognitive impairment in PCS.

Melatonin in hemicrania continua and paroxysmal hemicrania.

Hemicrania continua (HC) and paroxysmal hemicrania (PH) belong to a group of primary headache disorders called trigeminal autonomic cephalalgias. One of the diagnostic criteria for both HC and PH is the absolute response to the therapeutic dose of indomethacin. However, indomethacin is discontinued in many patients as a result of intolerance to its side effects. Melatonin, a pineal hormone, which shares similar chemical structure to indomethacin, has been reported to have some efficacy for HC in previous case reports and series. To our knowledge, there is no literature regarding the use of melatonin in PH. We aimed to describe the clinical use of melatonin in the preventive management of HC and PH. Patient level data were extracted as an audit from routinely collected clinical records in consecutive patients seen in outpatient neurology clinic at King's College Hospital, London, UK, from September 2014 to April 2023. Our cohort of patients were identified through a search using the keywords: hemicrania continua, paroxysmal hemicrania, melatonin and indomethacin. Descriptive statistics including absolute and relative frequencies, mean ± SD, median and interquartile range (IQR) were used. Fifty-six HC patients were included with a mean ± SD age of 52 ± 16 years; 43 of 56 (77%) patients were female. Melatonin was taken by 23 (41%) patients. Of these 23 patients, 19 (83%) stopped indomethacin because of different side effects. The doses of melatonin used ranged from 0.5 mg to 21 mg, with a median dose of 10 mg (IQR = 6-13 mg). Fourteen (61%) patients reported positive relief for headache, whereas the remaining nine (39%) patients reported no headache preventive effect. None of the patients reported that they were completely pain free. Two patients continued indomethacin and melatonin concurrently for better symptom relief. Eight patients continued melatonin as the single preventive treatment. Side effects from melatonin were rare. Twenty-two PH patients were included with mean ± SD age of 50 ± 17 years; 17 of 22 (77%) patients were female. Melatonin was given to six (27%) patients. The median dose of melatonin used was 8 mg (IQR = 6-10 mg). Three (50%) patients responded to melatonin treatment. One of them used melatonin as adjunctive treatment with indomethacin. Melatonin showed some efficacy in the treatment of HC and PH with a well-tolerated side effect profile. It does not have the same absolute responsiveness as indomethacin, at the doses used, although it does offer a well-tolerated option that can have significant ameliorating effects in a substantial cohort of patients.

The Lasting impact of the COVID-19 pandemic on outpatient neurology consultations

BackgroundThe COVID-19 pandemic prompted rapid changes in outpatient neurology services and there remain unanswered questions regarding its long-term impact. First, what are the lasting changes of the pandemic on demographics...

Childhood vertigo: A retrospective series of 791 cases

Background: Vertigo is one of the most common complaints leading to admissions in pediatric neurology clinics. Diagnosis of vertigo in children is often challenging due to limited communication capacity in defining symptoms, the unreliability of neurovestibular investigations in children and the variability of etiologies. The aim of this study is to evaluate clinical and etiological profile of vertigo in childhood and to assess the diagnostic yield of neuroimaging and electroencephalography (EEG). Methods: All patients under the age of 18 years presented with vertigo to the pediatric neurology outpatient clinic of Ankara Keçiören Research and Training Hospital were included in the study. Demographic data, accompanying symptoms, family history, physical and neurological examination findings, neuroimaging, and EEG results were retrospectively analyzed. The etiological spectrum was also evaluated according to age groups. Results: A total of 791 patients (female/male=2.1) with a mean age of 13.1 years were included in the study. The most common etiologies were vestibular migraine (27.3%) and psychogenic vertigo (14.9%) in the entire cohort; whereas benign paroxysmal vertigo of childhood was the top diagnosis in children ≤12 years (25%). The most common accompanying symptom was headache (36.7%) which was most frequently associated with vertigo attacks in migrainous patients. In most cases there was no correlation between neuroimaging findings and vertigo. Additionally, the contribution of EEG to the diagnosis was found to be limited. Conclusion: Most of the childhood vertigo cases can be diagnosed accurately by a detailed medical history, physical and neurological examination. A multidisciplinary approach is essential for evaluating childhood vertigo and all the signs and symptoms accompanying vertigo should be considered while planning further investigations including neuroimaging and EEG.

Relationships Between Age of Onset, Seizure Frequency, And Disease Duration with Cognitive Function in Epilepsy Patients at the Neurology Clinic of H. Adam Malik Central Hospital, Medan

Background: Cognitive function disorders often occur in individuals with epilepsy. The decline in cognitive function in epilepsy patients can be caused by various factors, including age of onset, seizure frequency, and duration of the disease. This study aims to investigate the relationship between the age of onset, seizure frequency, and disease duration on the cognitive function of epilepsy patients at the Neurology Outpatient Clinic of Haji Adam Malik General Hospital in Medan Method: The chosen research design is a cross-sectional analytic. The study was conducted at the neurology outpatient clinic of the Adam Malik Central General Hospital in Medan. The samples used were patients diagnosed with epilepsy at the Neurology Outpatient Clinic of Adam Malik Central General Hospital in Medan, aged 18-65 years, and without any other medical conditions aside from epilepsy. The study involved 35 subjects.Result: The majority of the research subjects are aged 18-45 years (94.3%), with more males (51.4%) than females. Most have a high school education background (48.6%), and the largest group is unemployed (62.9%). The most common age group at onset is 0-18 years (48.6%). The majority of subjects experience seizures in the rare category (less than 1 time per month) at 62.9%. Most subjects have a disease duration of less than 15 years (65.7%). The majority of epilepsy patients at the Neurology Outpatient Clinic of H. Adam Malik Hospital (52.1%) have abnormal cognitive function based on the MoCA-Ina test results. Statistical analysis was conducted using the chi-square test and multivariate analysis with logistic regression. The chi-square test results revealed a significant relationship between age of onset and cognitive function (p=0,008), a significant relationship between seizure frequency and cognitive function (p=0,004), and a significant relationship between disease duration and cognitive function (p=0,012). The multivariate analysis results indicated that disease duration had a significant relationship with cognitive function, with an odds ratio of 0,081 (p-value=0,037, 95% CI 0,008-0,862).Conclusion: There is a relationship between age of onset, seizure frequency, and disease duration with the cognitive function of epilepsy patients at the Neurology Outpatient Clinic of Haji Adam Malik General Hospital in Medan

Oral hygiene practices and status of stroke patients attending an outpatient clinic in a Nigerian tertiary hospital.

Background: There may be an impairment of oral self-care post-stroke which may compromise oral hygiene and health. However, there is paucity of information on oral hygiene and oral health status of stroke patients in Nigeria.&#x0D; Objective: To assess the oral hygiene and health status of stroke outpatients.&#x0D; Method: A cross-sectional study of stroke patients attending the neurology outpatient clinic of a tertiary hospital in North Central Nigeria was conducted. Data on sociodemographic variables and oral health behaviour was obtained. Each patient was examined to determine the oral hygiene status using the Simplified Oral Hygiene index, DMFT index for the status of caries, Modified gingival index for the presence or absence of gingival disease and Modified Rankin score for functional impairment&#x0D; Results: There were 120 participants with a mean age of 60.30±13.21 years. Poor oral hygiene status was found in 29.7% while 28.8% had good oral hygiene status. The mean DMFT was 1.37±2.672. Dental caries was seen in 48/120 (40%) while 28 (23.3%) had gingival diseases. A modified Rankin score of 3-5 was independently associated with poor oral hygiene status (OR 1.367; 95% CI 1.020-1.832; p=0.036).&#x0D; Conclusion: Poor oral hygiene status is common in patients with stroke and the risk of this is higher in those with poor functional status. Oral health status should be considered in the holistic rehabilitation of stroke patients.&#x0D;

Seizure control and complications in patients switching from clobazam to clonazepam due to drug shortage

BackgroundAntiseizure medication (ASM) shortages are a global problem that have a negative impact on outcomes such as seizure control in patients with epilepsy (PWE). In the case of clobazam (CLB) shortage, there is no study regarding the management strategy. This study aims to investigate the alteration in seizure frequency and the occurrence of side effects in PWE undergoing an abrupt switch from clobazam (CLB) to clonazepam (CLZ), during CLB shortage. Material and methodsA retrospective study was conducted from electronic health records at our neurology outpatient clinic from January to July 2022. Change in seizure frequency and percentage of CLZ-associated side effects were determined as primary and secondary outcomes, respectively. Potential drug-drug interactions (Level C and above) were evaluated by using Lexicomp Drug Interaction Checker. ResultsThe analysis included a total of 29 adult patients (15F, median age: 29). The switching ratio was 10 mg CLB for every 1 mg CLZ (10:1). Seizure frequency was higher during the CLZ period compared to the CLB period (p < 0.05), but no status epilepticus cases were observed. All patients exhibited potential drug-drug interactions, leading to reduced CLZ levels in 12 cases. A total of 36 CLZ-associated side effects were identified, with fatigue (19.4 %), drowsiness (16.6 %), and somnolence (13.8 %) being the most prevalent. A positive and strong correlation was found between CLZ dose and the number of side effects (r: 0.556; p: 0.002). ConclusionThe abrupt switch from CLB to CLZ was observed to increase seizure frequency without leading to status epilepticus in PWE. CLZ-associated side effects were found to be tolerable despite the abrupt switch. Future studies may explore the effect of alternative switching ratios.