Pub Date : 2022-10-18DOI: 10.56310/pjns.v17i01.172
Zara C. Shah, Haris Majid, Sadia Nishat, Sumera Riffat, S. Shafee, Ahmed A Wali, N. Shahbaz, M. Sheerani, M. Wasay
Novel data on Multiple Sclerosis (MS) in Pakistan from leading institutes in the country was presented at the first Pakistan Treatment in Multiple Sclerosis (PAKTRIMS) Conference, organized by the section of neurology, department of medicine, Aga Khan University, Karachi on Saturday, December 18, 2021. Pakistan has been considered to have a low prevalence of MS; however, recent research reveals that it is not as uncommon as previously believed to be in the country. The true prevalence and incidence of MS in the country is unknown because of dearth of research. Data of MS patients enrolled in various private and public institutes in Pakistan highlights the current treatment offered in Pakistan for MS patients with steroids as the mainstay treatment and disease modifying drugs (DMD) mainly including azathioprine, ocrelizumab and rituximab. Available data featuring disease progression indicates a successful response to the treatment offered to patients with improved expanded disability status scale (EDSS) and radiological findings. The conference was a steppingstone towards future research in MS in Pakistan as it highlighted what is furthered required to have a better picture of the disease in the country. Available data majorly outlines demographic characteristics and disease characteristics, however, there is a need for research to fill in the gap for data in reporting MS diagnosis, treatment, and disease outcome to develop a better healthcare system geared towards MS patients in a low- and middle-income Country (LMIC)
{"title":"Multiple sclerosis care in Pakistan; analysis of data presented at first PAKTRIMS conference ","authors":"Zara C. Shah, Haris Majid, Sadia Nishat, Sumera Riffat, S. Shafee, Ahmed A Wali, N. Shahbaz, M. Sheerani, M. Wasay","doi":"10.56310/pjns.v17i01.172","DOIUrl":"https://doi.org/10.56310/pjns.v17i01.172","url":null,"abstract":"Novel data on Multiple Sclerosis (MS) in Pakistan from leading institutes in the country was presented at the first Pakistan Treatment in Multiple Sclerosis (PAKTRIMS) Conference, organized by the section of neurology, department of medicine, Aga Khan University, Karachi on Saturday, December 18, 2021. Pakistan has been considered to have a low prevalence of MS; however, recent research reveals that it is not as uncommon as previously believed to be in the country. The true prevalence and incidence of MS in the country is unknown because of dearth of research. Data of MS patients enrolled in various private and public institutes in Pakistan highlights the current treatment offered in Pakistan for MS patients with steroids as the mainstay treatment and disease modifying drugs (DMD) mainly including azathioprine, ocrelizumab and rituximab. Available data featuring disease progression indicates a successful response to the treatment offered to patients with improved expanded disability status scale (EDSS) and radiological findings. The conference was a steppingstone towards future research in MS in Pakistan as it highlighted what is furthered required to have a better picture of the disease in the country. Available data majorly outlines demographic characteristics and disease characteristics, however, there is a need for research to fill in the gap for data in reporting MS diagnosis, treatment, and disease outcome to develop a better healthcare system geared towards MS patients in a low- and middle-income Country (LMIC)","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74051755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-18DOI: 10.56310/pjns.v17i01.151
Marium Mansoor, Nida Rahman Khan, A. Shafique
Huntington's disease (HD) is a rare, autosomal dominant, progressive neurodegenerative disorder. HD manifests with a triad of progressive motor, cognitive, and psychiatric symptoms. Our patient, a 39-years-old married female with over a nine-year history of psychotic symptoms. The patient was diagnosed and treated for schizophrenia. Over the last 2-3 years, the patient had a progressive decline in her Activities of Daily Living, instrumental activities of daily living, and psychotic symptoms. She developed slurred speech, gait disturbances, frequent falls, involuntary movements of the trunk and distal extremities, bowel and bladder incontinence, and severe weight loss. Her genetic test for Huntington’s gene confirmed the diagnosis of HD. She was prescribed Olanzapine, fluoxetine, and clonazepam. Psychotic symptoms are rare in HD and usually appear well after the motor and cognitive symptoms. Our case highlights an unusual clinical presentation of HD, which can be diagnostically challenging and lead to diagnostic delays.
{"title":"Prolonged psychosis before onset of neurological symptoms; an atypical clinical manifestation of Huntington’s disease","authors":"Marium Mansoor, Nida Rahman Khan, A. Shafique","doi":"10.56310/pjns.v17i01.151","DOIUrl":"https://doi.org/10.56310/pjns.v17i01.151","url":null,"abstract":"Huntington's disease (HD) is a rare, autosomal dominant, progressive neurodegenerative disorder. HD manifests with a triad of progressive motor, cognitive, and psychiatric symptoms. Our patient, a 39-years-old married female with over a nine-year history of psychotic symptoms. The patient was diagnosed and treated for schizophrenia. Over the last 2-3 years, the patient had a progressive decline in her Activities of Daily Living, instrumental activities of daily living, and psychotic symptoms. She developed slurred speech, gait disturbances, frequent falls, involuntary movements of the trunk and distal extremities, bowel and bladder incontinence, and severe weight loss. Her genetic test for Huntington’s gene confirmed the diagnosis of HD. She was prescribed Olanzapine, fluoxetine, and clonazepam. Psychotic symptoms are rare in HD and usually appear well after the motor and cognitive symptoms. Our case highlights an unusual clinical presentation of HD, which can be diagnostically challenging and lead to diagnostic delays. \u0000 ","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76082597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-18DOI: 10.56310/pjns.v17i01.167
Javeria Alvi, Muhammad HaiderSultan, Tipu Sultan
Anti-NMDAR encephalitis is a neuro-inflammatory disorder caused by antibodies targeting neurons in the central nervous system. Certain viruses break immune tolerance of neuronal proteins and increase the permeability of blood brain barrier (BBB) to antibodies resulting in post infectious autoimmunity. We report a case about a 13 years old girl diagnosed as a case of anti-NMDAR encephalitis, who presented with psychiatric symptoms followed by abnormal movements and encephalopathy, with later development of autonomic instability with tachycardia and blood pressure at 98th centile. Her thyroid profile initially showed hyperthyroidism with negative anti-thyroid antibodies with subsequent normalization without anti-thyroid drug. Her SARS-CoV-2 IgM was positive despite being asymptomatic that had induced autoimmunity in central nervous system and caused transient thyroiditis. She poorly responded to first tier immune therapy (methylprednisolone pulse & plasmapheresis) but there was remarkable response to second tier immune therapy with Rituximab with prompt attainment of ambulation and self care.
{"title":"Post COVID anti-NMDAR Encephalitis in an adolescent girl","authors":"Javeria Alvi, Muhammad HaiderSultan, Tipu Sultan","doi":"10.56310/pjns.v17i01.167","DOIUrl":"https://doi.org/10.56310/pjns.v17i01.167","url":null,"abstract":"Anti-NMDAR encephalitis is a neuro-inflammatory disorder caused by antibodies targeting neurons in the central nervous system. Certain viruses break immune tolerance of neuronal proteins and increase the permeability of blood brain barrier (BBB) to antibodies resulting in post infectious autoimmunity. We report a case about a 13 years old girl diagnosed as a case of anti-NMDAR encephalitis, who presented with psychiatric symptoms followed by abnormal movements and encephalopathy, with later development of autonomic instability with tachycardia and blood pressure at 98th centile. Her thyroid profile initially showed hyperthyroidism with negative anti-thyroid antibodies with subsequent normalization without anti-thyroid drug. Her SARS-CoV-2 IgM was positive despite being asymptomatic that had induced autoimmunity in central nervous system and caused transient thyroiditis. She poorly responded to first tier immune therapy (methylprednisolone pulse & plasmapheresis) but there was remarkable response to second tier immune therapy with Rituximab with prompt attainment of ambulation and self care.","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"104 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80557162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-18DOI: 10.56310/pjns.v17i01.161
Sohail Ahmad Khan, Asvad A. Khan, Asiyah Ahmad
Objectives: We hypothesized that the students who are forced to enter the medical field by their parents may have a higher incidence of depression and anxiety. Methods: A total of 210 medical and dental students were asked to fill out a form indicating their desire to enter medical college versus their parents’ wishes on an analogue scale. They were also asked to fill out screening forms for depression and anxiety. Results: The students who selected the medical field by their parent’s wishes were found to have 1.2 times more anxiety & 1.96 times more depression. Conclusions: The parents should consider their child's willingness to enter the medical field before forcing him / her into the medical school.
{"title":"Screening for depression and anxiety in medical and dental students who are forced into their field of study","authors":"Sohail Ahmad Khan, Asvad A. Khan, Asiyah Ahmad","doi":"10.56310/pjns.v17i01.161","DOIUrl":"https://doi.org/10.56310/pjns.v17i01.161","url":null,"abstract":"Objectives: We hypothesized that the students who are forced to enter the medical field by their parents may have a higher incidence of depression and anxiety. \u0000 \u0000Methods: A total of 210 medical and dental students were asked to fill out a form indicating their desire to enter medical college versus their parents’ wishes on an analogue scale. They were also asked to fill out screening forms for depression and anxiety. \u0000 \u0000Results: The students who selected the medical field by their parent’s wishes were found to have 1.2 times more anxiety & 1.96 times more depression. \u0000 \u0000Conclusions: The parents should consider their child's willingness to enter the medical field before forcing him / her into the medical school.","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"112 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76614237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-18DOI: 10.56310/pjns.v17i01.186
S. Khan, Soban Khan, Zaid Waqar, Hafsa Mobeen, N. Khan, Muhammad Hassan
Due to pervasive pandemic of SARS CoV-2 the reports of rare neurological complications have turned up out of the ordinary. The public health concerns are raised due to SARS-CoV-2 infection and vaccinations as this recent pandemics has set the development and deployment of vaccines at large scale. The randomized controlled trials being carried were underpowered to foresee these rare adverse effects. Amongst other neurological complications acute disseminated encephalomyelitis ADEM has been reported with vaccination for SARS-CoV-2. Herein, we report a patient with a unique presentation of ADEM, a severe neuroinflammatory disorder developed shortly after mRNA based Moderna vaccine for SARS-CoV-2.
{"title":"Post Moderna Vaccine associated acute disseminated encephalomyelitis (ADEM) - A case report.","authors":"S. Khan, Soban Khan, Zaid Waqar, Hafsa Mobeen, N. Khan, Muhammad Hassan","doi":"10.56310/pjns.v17i01.186","DOIUrl":"https://doi.org/10.56310/pjns.v17i01.186","url":null,"abstract":"Due to pervasive pandemic of SARS CoV-2 the reports of rare neurological complications have turned up out of the ordinary. The public health concerns are raised due to SARS-CoV-2 infection and vaccinations as this recent pandemics has set the development and deployment of vaccines at large scale. The randomized controlled trials being carried were underpowered to foresee these rare adverse effects. Amongst other neurological complications acute disseminated encephalomyelitis ADEM has been reported with vaccination for SARS-CoV-2. Herein, we report a patient with a unique presentation of ADEM, a severe neuroinflammatory disorder developed shortly after mRNA based Moderna vaccine for SARS-CoV-2.","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76769342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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