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Aldriweesh MA, Aldbas AA, Khojah O, Yonbawi F, Shafaay EA, Aljahdali GL, Alshalhoub M, Bukhari MK, Qari Y, Almuntashri MM, Alshaikh AA, Alotaibi N, Almuntashri MA, Khathaami AMA, Makkawi S, Ghamdi SA. Clinical characteristics, Risk factors, and outcomes of Posterior circulation stroke: A retrospective study between younger and older adults in Saudi Arabia. J Stroke Cerebrovasc Dis 2024; 33:107676. [PMID: 38492657 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/13/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024] Open
Abstract
INTRODUCTION Posterior circulation stroke (PCS) may be less prevalent than its anterior counterpart but contributes to substantial morbidity and mortality. The aim was to characterize PCS's demographics, clinical presentation, management, and outcomes between younger and older adults in Saudi Arabia. METHODS This retrospective cohort study was conducted at two tertiary medical centers in Saudi Arabia between March 2016 and December 2020. All patients who presented with symptoms of posterior circulation stroke and had positive brain imaging were included. RESULTS The study involved 160 posterior circulation stroke patients, stratified into two age groups: 71 patients aged 18-59 years and 89 patients aged 60 years and above. The mean age of the entire cohort was 60.9 years, and 77 % were males. Hypertension was more prevalent in the older age group (88 % vs. 69 %, p=0.005), and smoking was significantly higher among younger patients (38 % vs. 15 %; p=0.0009). Only 22.4 % received thrombolysis and/or thrombectomy. Most strokes involved the posterior cerebral artery (45.6 %). Large artery atherosclerosis was the most common subtype. At discharge, younger patients had higher NIHSS compared to older patients. CONCLUSION Our investigation of 160 PCS patients in Saudi Arabia uncovers notable trends: a mere 22.4 % received thrombolysis and/or thrombectomy and a significant prevalence of posterior cerebral artery involvement due to large artery atherosclerosis. The study further reveals younger patients disproportionately had severe outcomes. Highlighting the need for improved stroke care and heightened awareness, this research contributes vital data to an underexplored domain, urging further study to optimize care and understand PCS dynamics in Saudi Arabia.
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Affiliation(s)
- Mohammed A Aldriweesh
- Department of Neurology, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaziz A Aldbas
- Department of Neurology, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Osama Khojah
- Department of Neurosciences, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Faisal Yonbawi
- Department of Neurosciences, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Edi A Shafaay
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; Department of Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Ghadeer L Aljahdali
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Alshalhoub
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; Emergency Department, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Khalid Bukhari
- Emergency Department, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
| | - Yousef Qari
- King Abdullah International Medical Research Center, Jeddah, Kingdom of Saudi Arabia; Department of Neurology, King Abdullah Medical Complex, Ministry of Health, Jeddah, Kingdom of Saudi Arabia
| | - Manar M Almuntashri
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Aljoharah A Alshaikh
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; Neuroradiology Department, King Abdulaziz Medical City Riyadh, Kingdom of Saudi Arabia
| | - Naser Alotaibi
- Department of Neurology, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Makki A Almuntashri
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; Neuroradiology Department, King Abdulaziz Medical City Riyadh, Kingdom of Saudi Arabia
| | - Ali M Al Khathaami
- Department of Neurology, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Seraj Makkawi
- Department of Neurosciences, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Saeed Al Ghamdi
- Division of Neurology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center Jeddah, Kingdom of Saudi Arabia.
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Makkawi S, Aljafari D, Alsharif R, Maaddawi H, Alwagdani A, Aljumah T, Alghweinem Z, Alshehri S, Khojah O, Halawani A, Ahmed Adas R, Abulaban A, Al Malik Y. The clinical and radiological features and prevalence of Neuro-Behçet's Disease: A retrospective cohort multicenter study in Saudi Arabia. Mult Scler Relat Disord 2024; 85:105558. [PMID: 38569381 DOI: 10.1016/j.msard.2024.105558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 02/22/2024] [Accepted: 03/16/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Neuro-Behçet's disease (NBD) is defined as primary neurological involvement in patients with systemic symptoms of BD. The variety of clinical presentations seen in NBD and the long list of similar conditions make diagnosis challenging. This retrospective study aimed to estimate the prevalence and describe neurological involvement in patients with Behçet's disease who presented to King Abdulaziz Medical Cities in Jeddah and Riyadh, Saudi Arabia. METHODS This was a retrospective, cohort study which utilized a non-probability consecutive sampling technique to include all patients diagnosed with NBD patients. All patients with BD (215) were screened for neurological symptoms. Thirty-five patients were found to be diagnosed with NBD. Outcomes were estimated using the modified Rankin scale (mRS). RESULTS In our cohort, one in six patients with BD was diagnosed with NBD. A total of 35 patients were diagnosed with NBD (mean age 27.56 ± 10.36 years; [2.88:1; Male: Female]). The main clinical features of NBD were headaches, weakness, unsteadiness, and dysarthria. The most commonly involved sites on imaging were the brainstem, diencephalon, cerebellum and basal ganglia. Oligocolonal bands were negative in all patients. Maintenance therapy most commonly included oral corticosteroids, azathioprine, and/or infliximab. Most patients received pulse corticosteroids alone when presenting with acute relapse. Half of our cohort was asymptomatic and three in four had favorable outcomes. CONCLUSION NBD is common among patients with BD in our population with most patients having favorable outcomes. Patients might have a wide array of symptoms which might make the diagnosis challenging.
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Affiliation(s)
- Seraj Makkawi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Danya Aljafari
- Neuroscience Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Rawaf Alsharif
- Neurology Division, Department of Medicine, Ministry of The National Guard-Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hadeel Maaddawi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Alhanouf Alwagdani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Talal Aljumah
- Neurology Division, Department of Medicine, Ministry of The National Guard-Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ziyad Alghweinem
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sultan Alshehri
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Osama Khojah
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Aisha Halawani
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Medical Imaging, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Reem Ahmed Adas
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Medical Imaging, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Ahmad Abulaban
- Neurology Division, Department of Medicine, Ministry of The National Guard-Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yaser Al Malik
- Neurology Division, Department of Medicine, Ministry of The National Guard-Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Makkawi S, Salamatullah HK, Alkhiri A, Faidah DE, Afif LM, Bukhari JI, Abulaban A, Al Malik Y, Levy M. Role of C5 inhibitors in neuromyelitis optica spectrum disorders with seropositive anti-aquaporin-4 antibody: A systematic review and meta-analysis. Mult Scler Relat Disord 2024; 85:105524. [PMID: 38479045 DOI: 10.1016/j.msard.2024.105524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/11/2024] [Accepted: 02/26/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disorder characterized by relapses of inflammation and demyelination primarily affecting the optic nerve and the spinal cord. C5 complement inhibition is an effective therapeutic approach in the treatment of NMOSD. In this systematic review and meta-analysis, we aimed to determine the role of C5 inhibitors in the treatment of patients with seropositive anti-aquaporin-4 antibody (AQP4+IgG) NMOSD. METHODS This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Relevant articles were systematically searched through Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases until October 6th, 2023. We included randomized clinical trials (RCTs) that investigated the treatment with C5 inhibitors compared to placebo in patients with seropositive NMOSD. The primary endpoint was the rates of first adjudicated relapse. Secondary endpoints included different disability and quality of life measures. The random-effects model was used for all statistical analyses. RESULTS Two RCTs with a total of 201 patients were included. C5 inhibitors demonstrated significant reduction of first adjudicated relapse (risk ratio (RR) = 0.05, 95 % CI 0.01-0.15) and Hauser Ambulation Index (HAI) (mean difference (MD): -0.79, 95 % CI -1.27 to -0.31). There was no significant difference between the two groups in Expanded Disability Status Scale (EDSS) (MD -0.23, 95 % CI -0.54-0.08). C5 inhibitors significantly improved the mean change in EQ-5D index (MD 0.08, 95 % CI 0.01-0.14; P = 0.02); however, no significant difference was shown in the mean change in EQ-5D VAS (MD 3.79, 95 % CI -1.61 to 9.19; P = 0.17). Safety measures were comparable between C5 inhibitors and placebo. CONCLUSION NMOSD Patients with AQP4+IgG receiving C5 inhibitors have lower rate of relapses and improved levels of disability and quality of life. Real-world studies are warranted to establish the long-term safety of C5 inhibitors.
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Affiliation(s)
- Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Neurosciences, Ministry of The National Guard-Health Affairs, Jeddah, Saudi Arabia.
| | - Hassan K Salamatullah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed Alkhiri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Dania E Faidah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Lena M Afif
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Jawad I Bukhari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmad Abulaban
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Neurology Division, Department of Medicine, Ministry of The National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Yaser Al Malik
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Neurology Division, Department of Medicine, Ministry of The National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Michael Levy
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Makkawi S, Maglan A, Khojah O, Allaf F, Alamoudi S, Ahmed ME, Alsharif R, Altayeb M, Alharthi A, Abulaban A, Al Malik Y. Patterns of multiple sclerosis presentation to the emergency department. Front Neurol 2024; 15:1395822. [PMID: 38737348 PMCID: PMC11082281 DOI: 10.3389/fneur.2024.1395822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024] Open
Abstract
Background Multiple sclerosis (MS) patients are no strangers to the emergency department (ED) due to the relapsing and progressive nature of the disease and the associated complications. This study aimed to identify patterns of ED visits among patients diagnosed with MS, the underlying causes of these visits, and the factors associated with these visits. Methods This was a single center retrospective cohort study which utilized a non-probability consecutive sampling technique to include all patients diagnosed with MS (471 patients) from March 2016 to October 2021 in King Abdulaziz Medical City, Jeddah, Saudi Arabia. ED visits were categorized as directly related to MS, indirectly related to MS, or unrelated to MS. Results One in four people with MS visited the ED at least once with a total of 280 ED visits. Most ED visits were ones directly related to MS 43.6%, closely followed by unrelated to MS 41.1%, and then indirectly-related MS visits 15.4%. The most common presenting symptoms in directly-related MS visits were weakness 56.6% and numbness/tingling 56.6% followed by gait impairment 29.5%. Indirectly related to MS or unrelated to MS ED visits were commonly due to neurological 17.7% and gastrointestinal 17.1% causes. Using disease modifying therapy (DMT) was significantly associated with no ED visits (p < 0.001). The use of high-efficacy DMTs was significantly associated with no ED visits than using moderate efficacy DMT (p < 0.001). The use of B-cell depleting therapy (ocrelizumab and rituximab) was significantly associated with no visits to the ED than using any other DMT (p < 0.001). Evidence of brain atrophy on imaging was significantly associated with patients who presented to the ED ≥3 times (p = 0.006, UOR = 3.92). Conclusion Due to the nature of the disease, many MS patients find themselves visiting the ED due to MS related and unrelated issues. These patients are not only required to be treated by neurologists but also by multiple disciplines. The use of high-efficacy DMTs and B-cell depleting therapy may reduce the total frequency of ED visits. Special attention should be paid to patients who have evidence of brain atrophy on imaging.
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Affiliation(s)
- Seraj Makkawi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Alaa Maglan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Osama Khojah
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Faris Allaf
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Saeed Alamoudi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Fellowship and Residency Training Program, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Mohamed Eldigire Ahmed
- College of Basic Sciences and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Rawaf Alsharif
- Department of Neurology, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Meral Altayeb
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Surgery, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Abdulrhman Alharthi
- Department of Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Ahmad Abulaban
- Department of Neurology, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yaser Al Malik
- Department of Neurology, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Alkhiri A, Alturki F, Alansari NM, Almaghrabi AA, Alghamdi BA, Alamri AF, Alghamdi S, Makkawi S. Prognosis and distribution of ischemic stroke with negative diffusion-weighted imaging: a systematic review and meta-analysis. Front Neurol 2024; 15:1376439. [PMID: 38737347 PMCID: PMC11082379 DOI: 10.3389/fneur.2024.1376439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/17/2024] [Indexed: 05/14/2024] Open
Abstract
Background Magnetic resonance diffusion-weighted imaging (DWI) is the most sensitive modality for ischemic stroke diagnosis. However, DWI may fail to detect ischemic lesions in a proportion of patients. Methods Following PRISMA statement, a systematic search of Medline, Embase, and Web of Science was conducted until January 3, 2024. The inclusion was confined to English literature with sufficient reporting. Proportions of DWI-negative ischemic stroke were pooled. For binary variables, odds ratios (ORs) were computed using the random-effects model. Results Fourteen studies constituting 16,268 patients with a clinical diagnosis of ischemic stroke and available DWI findings were included. Intravenous thrombolysis (IVT) was administered to 19.6% of the DWI-negative group and 15.3% of the DWI-positive group. DWI-negative ischemic stroke was reported in 16% (95% CI: 10-24%; after sensitivity analysis: 11% [95% CI: 8-15%]) of stroke patients. Among minor stroke patients (National Institutes of Health Stroke scale [NIHSS] of 5 or less), 24% (95% CI 12-42%) had negative DWI findings. Predictors of DWI-negative scans included posterior circulation stroke, history of ischemic heart disease, prior stroke, or prior transient ischemic attack. Cardioembolic stroke (OR, 0.62, 95% CI: 0.41-0.93) and history of atrial fibrillation increased the likelihood of positive DWI findings (OR, 0.56, 95% CI: 0.45-0.71). Patients with DWI-negative ischemic stroke had higher odds of good functional outcomes (modified Rankin scale [mRS] of 0-1) (OR, 2.26; 95% CI: 1.03-4.92), lower odds of stroke recurrence (OR, 0.68; 95% CI: 0.48-0.96), and lower odds of severe disability or mortality (mRS of 3-6) (OR, 0.44; 95% CI: 0.34-0.57) compared to patients with positive DWI. Rates of symptomatic intracerebral hemorrhage after IVT were comparable between groups. Conclusion DWI-negative findings were present in a significant proportion of ischemic stroke patients and may be utilized as a marker for favorable prognosis.
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Affiliation(s)
- Ahmed Alkhiri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Fahad Alturki
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nayef M. Alansari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed A. Almaghrabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Basil A. Alghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Aser F. Alamri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Saeed Alghamdi
- Neuroscience Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Neuroscience, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
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Halawani A, Aljabri A, Bahathiq DM, Morya RE, Alghamdi S, Makkawi S. The efficacy of contralaterally controlled functional electrical stimulation compared to conventional neuromuscular electrical stimulation for recovery of limb function following a stroke: a systematic review and meta-analysis. Front Neurol 2024; 15:1340248. [PMID: 38450065 PMCID: PMC10915254 DOI: 10.3389/fneur.2024.1340248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/30/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Limb paresis following a stroke is a common sequela that can impact patients' quality of life. Many rehabilitation strategies targeting the restoration of motor function exist. This systematic review and meta-analysis aim to evaluate the effects of contralaterally controlled functional electrical stimulation (CCFES) as a modality for limb rehabilitation. Unlike conventional neuromuscular electrical simulation (NMES), the contra-laterality in CCFES is achieved by two methods a bend angle sensor or an electromyographic bridge (EMGB) method, both of which targets signals from the unaffected limb. Method This review study was performed following the preferred reporting item for systematic review and meta-analysis (PRISMA) guidelines. Records that met the inclusion criteria were extracted from the following databases: Medline, Embase, and Cochrane Register of Controlled Trials (CENTRAL). Additional articles were also retrieved from clinicaltrials.gov and China/Asia on Demand (CAOD). Only randomized controlled studies (RCTs) were included. Results Sixteen RCTs met the inclusion criteria, and 14 of which were included in the quantitative analysis (meta-analysis). The results of the analysis show that when compared to conventional NMES, CCFES displayed a better improvement in the upper extremity Fugl-Meyer assessment (UEFMA) (SMD = 0.41, 95% CI: 0.21, 0.62, p-value <0.0001, I2 = 15%, GRADE: moderate), box and blocks test (BBT) (SMD = 0.48, 95% CI: 0.10, 0.86, p-value = 0.01, I2 = 0%, GRADE: very low), modified Barthel index (mBI) (SMD = 0.44, 95% CI: 0.16, 0.71, p-value = 0.002, I2 = 0%, GRADE: moderate), active range of motion (AROM) (SMD = 0.61, 95% CI: 0.29, 0.94, p-value = 0.0002, I2 = 23%, GRADE: moderate), and surface electromyography (sEMG) scores (SMD = 0.52, 95% CI: 0.14, 0.90, p-value = 0.008, I2 = 0%, GRADE: low). The results of the subgroup analysis for the type of sensor used in CCFES shows that an EMGB (SMD = 0.58, 95% CI: 0.33, 0.84, p-value <0.00001, I2 = 7%) is more effective than a bend angle sensor (SMD = 0.17, 95% CI: -0.12, 0.45, p-value = 0.25, I2 = 0%). Conclusion The results of this study provide strong evidence that shows CCFES being a better electrical stimulation modality compared to conventional NMES. This could be explained by the fact that CCFES is bilateral in nature which offers a platform for better neuroplasticity following a stroke. There is still a need for high-quality studies with a standardized approach comparing CCFES to other treatment modalities. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=342670, identifier CRD42022342670.
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Affiliation(s)
- Alhussain Halawani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ammar Aljabri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Dena M. Bahathiq
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Roaa E. Morya
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Saeed Alghamdi
- Neuroscience Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Neuroscience, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
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Zahhar JA, Salamatullah HK, Almutairi MB, Faidah DE, Afif LM, Banjar TA, Alansari N, Betar M, Alghamdi S, Makkawi S. Influenza vaccine effect on risk of stroke occurrence: a systematic review and meta-analysis. Front Neurol 2024; 14:1324677. [PMID: 38269000 PMCID: PMC10806129 DOI: 10.3389/fneur.2023.1324677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/14/2023] [Indexed: 01/26/2024] Open
Abstract
Background Stroke is a significant global cause of mortality and long-term disability, potentially influenced by infections that heighten systemic inflammation and thrombotic events. The full impact of influenza vaccination on stroke remains uncertain. This systematic review and meta-analysis aimed to investigate the association between influenza immunization and stroke incidence. Methods We searched for randomized controlled trials (RCTs), case-control, and cohort studies published in PubMed/Medline, Cochrane-Central-Register-of-Controlled-Trials (CENTRAL), and Embase until 5 December 2022, and identified articles investigating the effect of influenza vaccine on stroke occurrence. All articles were screened by two independent reviewers. We performed a meta-analysis to investigate the risk of stroke occurrence in vaccinated vs. unvaccinated individuals. The random-effects model was used in all statistical analyses. Results Among the 26 articles meeting our criteria, 10 were retrospective cohort studies, 9 were case-control studies, 3 were prospective cohort studies, 3 were RCTs and 1 case-series. Overall, the studies showed a significant decrease in the risk of stroke incidence/hospitalization among vaccinated patients (OR = 0.81, 95% CI [0.77-0.86], p = 0.00001). Furthermore, studies showed flu vaccine decreases the occurrence of mortality among stroke patients (OR = 0.50, 95% CI [0.37-0.68], p = 0.00001). Sub-group analysis revealed significant protective effect for patients with specific comorbidities including atrial fibrillation (OR = 0.68, 95% CI [0.57-0.81], p = 0.0001), diabetes (OR = 0.76, 95% CI [0.66-0.87], p = 0.0001), Chronic obstructive pulmonary disease (OR = 0.70, 95% CI [0.61-0.81], p = 0.00001), and hypertension (OR = 0.76, 95% CI [0.70-83], p = 0.00001). Conclusion The current meta-analysis further supports prior findings that influenza vaccination reduces stroke risk, particularly in patients with comorbidities. Guidelines should promote vaccination for at-risk individuals.
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Affiliation(s)
- Jalal A. Zahhar
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Hassan K. Salamatullah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Maher B. Almutairi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Dania E. Faidah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Lena M. Afif
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Toka A. Banjar
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Nayef Alansari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Manar Betar
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Saeed Alghamdi
- Neuroscience Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
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Makkawi S, Khojah O, Abualnaja R, Qashqari A, Alahmadi NA, Bshnaq AG, Alharthi A, Al-Hashemi HH, Shawli AM. Fibrodysplasia Ossificans Progressiva Mimics Generalized Dystonia Disorder: A Case Report. Cureus 2023; 15:e50769. [PMID: 38269236 PMCID: PMC10806276 DOI: 10.7759/cureus.50769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/26/2024] Open
Abstract
Fibrodysplasia ossificans progressiva (FOP) is an autosomal dominant disorder characterized by congenital deformities of the big toes and the progressive formation of extra-skeletal bone within soft tissues. The underlying genetic cause of FOP is mostly due to gain-of-function mutations in the AVCR1/ALK2 genes. These mutations cause aberrant bone morphogenetic protein (BMP) signaling pathways and eventually result in cumulative musculoskeletal impairment. FOP has a prevalence of approximately one in every 2 million people worldwide, with nearly 90% of patients being misdiagnosed, possibly leading to an underestimation of its true prevalence. To the best of our knowledge, there are only three reported cases in Saudi Arabia. We report a case of a 21-year-old female patient, a product of a consanguineous marriage, referred to the neurology clinic for new-onset dysphagia and dysarthria in association with progressive painful muscle stiffness, which started at the age of four years. The diagnosis of generalized dystonia disorder was suspected, but eventually the whole exome sequencing showed a pathogenic missense mutation in the ACVR1 gene, confirming the diagnosis of FOP. FOP is a rare, debilitating disorder that can be difficult to diagnose and manage. Current research efforts are focused on early diagnosis and a high index of suspicion to help prevent unnecessary investigations and procedures, slow the progression of the disease, and promote patients' quality of life and long-term outcomes.
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Affiliation(s)
- Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
- Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, SAU
| | - Osama Khojah
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
- Department of Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, SAU
| | - Reema Abualnaja
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Abdulaziz Qashqari
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Nawaf A Alahmadi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Abdullatif G Bshnaq
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Abdulrahman Alharthi
- Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Hashem H Al-Hashemi
- Medicine, Ministry of the National Guard-Health Affairs, Jeddah, SAU
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Aiman M Shawli
- Genetics and Precision Medicine, Ministry of the National Guard-Health Affairs, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
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9
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Salamatullah HK, Bashrahil B, Alghamdi AM, Alsharm FS, Alkulli OA, Alzahrani Z, Alkhiri A, Alghamdi S, Makkawi S. Efficacy and safety of tenecteplase in comparison to alteplase in acute ischemic stroke: A systematic review and meta-analysis of randomized controlled trials. Clin Neurol Neurosurg 2023; 233:107961. [PMID: 37713743 DOI: 10.1016/j.clineuro.2023.107961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/01/2023] [Accepted: 09/03/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Alteplase is the standard medical therapy for acute ischemic stroke (AIS) patients who present within 4.5 h of symptom onset. Tenecteplase is a modified alteplase variant with pharmacological and practical advantages over alteplase. Many trials have investigated the efficacy and safety of tenecteplase against alteplase. This systematic review and meta-analysis aimed to compare the efficacy and safety of tenecteplase to alteplase across randomized controlled trials. METHOD Medline, Embase, and Cochrane CENTRAL were used to search the related articles until February 20, 2023. Randomized controlled trials (RCTs) that compared the effectiveness and safety of tenecteplase against alteplase for AIS patients were included. Screening, risk of bias assessment, and data extraction were performed following PRISMA guidelines. Data were pooled using a random-effect model. RESULTS Ten RCTs were included, with a total of 5123 patients. There was no significant difference between the two interventions in modified rankin scale 0-1 (mRS 0-1) (RR= 1.04, 95% CI [0.99-1.10], P = 0.11, I2 =0%) and early neurological improvement (RR= 1.06, 95% CI [0.97-1.15], P = 0.21, I2 =35). There was no difference in the rates of symptomatic intracranial hemorrhage (RR= 1.18, 95% CI [0.84-1.65], P = 0.35, I2 = 0%). Tenecteplase was associated with significantly higher complete recanalization rate compared to alteplase (RR= 1.17, 95% CI [1.00-1.36], P = 0.05, I2 =0%). For large vessel occlusion (LVO) patients assigned to tenecteplase, there was a significant improvement in mRS 0-1 (RR= 1.28, 95% CI [1.07-1.52], P = 0.006, I2 =0%). CONCLUSION Based on our meta-analysis, tenecteplase has similar efficacy and safety to alteplase, with a more promising effect in patients with LVO.
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Affiliation(s)
- Hassan K Salamatullah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Bader Bashrahil
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdulaziz M Alghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Faisal S Alsharm
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Osama A Alkulli
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ziyad Alzahrani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed Alkhiri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Saeed Alghamdi
- Neuroscience Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia.
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10
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Alswat AM, Altirkistani BA, Alserihi AR, Baeshen OK, Alrushid ES, Alkhudair J, Aldbas AA, Wadaan OM, Alsaleh A, Al Malik YM, Abulaban AA, Makkawi S. The prevalence of major depression and generalized anxiety disorder in patients with multiple sclerosis in Saudi Arabia: a cross-sectional multicentered study. Front Psychiatry 2023; 14:1195101. [PMID: 37706033 PMCID: PMC10496114 DOI: 10.3389/fpsyt.2023.1195101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/04/2023] [Indexed: 09/15/2023] Open
Abstract
Background Multiple sclerosis (MS) is an autoimmune disease characterized by chronic, progressive neurodegeneration of the central nervous system (CNS), and it is the most common inflammatory neurological disease affecting young adults. Given the chronic, progressive nature of the disease, psychiatric disorders are more prevalent among these patients, as reported in the literature; however, data in Saudi Arabia are limited. This study aimed to estimate the prevalence of major depression and generalized anxiety disorder in patients with MS and their association with different patient demographics. Methods This was a cross-sectional, multicentered study that included adult patients with MS from 30 June 2021 to 30 June 2022. Participants were interviewed in person and asked to complete a survey that included general demographics, the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) questionnaire. Other variables related to the patients' conditions, such as MS type and Expanded Disability Status Scale (EDSS) score, were collected from the patient's electronic records. Descriptive statistics were performed, and associations were made using the chi-square, Fisher's exact, and analysis of variance tests, as appropriate. Results A total of 192 participants were included in this study. Based on a cutoff score of >10 on the GAD-7 and PHQ-9 scales, the prevalence of generalized anxiety disorder was 26.1% (50), with the majority of participants having minimal anxiety (40%); meanwhile, the prevalence of major depression was 42.7% (n = 82), and most of them had mild depression (30%). Female participants scored significantly higher compared to men on the GAD-7 scale (p = 0.0376), but not on the PHQ-9 scale (p = 0.1134). In addition, no statistically significant association was detected between functional disability (EDSS score) and prevalence of anxiety and depression. Conclusion This study demonstrated a high prevalence of generalized anxiety disorder and major depression among patients with MS compared with that in the general population, with women being more affected. As these comorbid disorders could negatively affect the disease course, screening is of paramount significance.
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Affiliation(s)
- Anas M. Alswat
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Bsaim A. Altirkistani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Anas R. Alserihi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Osama K. Baeshen
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Eythar S. Alrushid
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Joud Alkhudair
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulaziz A. Aldbas
- Division of Neurology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Osama M. Wadaan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmad Alsaleh
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Yaser M. Al Malik
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Division of Neurology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ahmad A. Abulaban
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Division of Neurology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Seraj Makkawi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Jeddah, Saudi Arabia
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11
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Al-Khawajah MM, Al-Barakati RG, Al-Jedai AH, Al-Malik YM, Al-Mudaiheem HY, Al-Omari BA, Al-Thubaiti IA, Al-Yafeai RH, Bunyan RF, Cupler EJ, Hakami M, Kedah HM, Makkawi S, Saeed LH, Saeedi JA, Shosha E, Al-Jumah MA. Saudi Consensus Recommendations on the Management of Multiple Sclerosis: Family Planning within the Management of MS. CTN 2023. [DOI: 10.3390/ctn7020010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
This review article addresses the complex issues faced by individuals with Multiple Sclerosis (MS) who are planning a family, becoming pregnant, or wishing to breastfeed their baby. Recommendations and guidelines were discussed and agreed upon by neurologists, neuroradiologists, nurses, and pharmacists involved in the management of MS in the Kingdom of Saudi Arabia (KSA). MS itself does not harm a pregnancy, and people with MS of childbearing age can be encouraged to enjoy family life. Family planning should be a part of the initial conversation with a newly diagnosed patient of childbearing age. Interferons and glatiramer acetate can be continued throughout pregnancy and can be administered during breastfeeding if the benefits outweigh the risks. These DMTs may be considered for a woman with well-controlled MS who is planning a pregnancy or otherwise not using contraception, according to an individualized risk-benefit analysis. The use of contraception should be maintained during the administration of other disease-modifying therapies (DMTs). Natalizumab can be administered at a reduced administration frequency to women with high MS disease activity up to 30 weeks gestation (this agent may induce hematological abnormalities in the fetus). Other DMTs should be withdrawn for variable periods before contraception is stopped and immediately after the discovery of a pregnancy (beware of rebound disease activity after withdrawing natalizumab or fingolimod). Resumption of treatment should not be delayed in women at risk of relapse during the postpartum period and especially in those who do not wish to breastfeed.
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12
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Alamri NM, Alhumaidan HA, Althekair F, Makkawi S, Malik YA, Abulaban AA. Status of Cerebrospinal Fluid Oligoclonal Bands Among Patients with Multiple Sclerosis MS at King Abdulaziz Medical City. Mult Scler Relat Disord 2023. [DOI: 10.1016/j.msard.2022.104329] [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: 04/03/2023]
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13
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Hmoud M, Salamatullah HK, Faidah DE, Makkawi S. Experience and perception of utilizing virtual clinic in neurological assessment in Saudi Arabia. Front Neurol 2023; 14:1111254. [PMID: 36873439 PMCID: PMC9983690 DOI: 10.3389/fneur.2023.1111254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/25/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction The World Health Organization defined electronic health as "the unified usage of information technology and electronic communications in the health sector." In the Kingdom of Saudi Arabia, outpatient encounters were largely shifted to virtual clinics due to the crisis caused by COVID-19. This study aimed to evaluate the neurology consultants', specialists', and residents' experience and perception of utilizing virtual services for neurological assessment in Saudi Arabia. Methods This cross-sectional study was conducted by sending an anonymous online survey to neurologists and neurology residents in Saudi Arabia. The survey was developed by the authors and contained three main sections: demographics, subspecialty and years of experience after residency, and virtual clinics during the coronavirus disease 2019 (COVID-19) pandemic. Result A total of 108 neurology-practicing physicians in Saudi Arabia responded to the survey. Overall, 75% experienced virtual clinics, and 61% of them used phones for consultation. In neurology clinical practice, there was a significant difference (P < 0.001) regarding the teleconsultations for follow-up patients compared to the newly referred patients, being more suitable for the follow-up cases. Additionally, most neurology practicing physicians showed more confidence in performing history-taking tasks virtually (82.4%) than in physical examination. However, it was found that consultants were significantly (P < 0.03) more confident to virtually perform the cranial nerve, motor, coordination, and extrapyramidal assessments than the neurology residents. Physicians deemed it more suitable to conduct teleconsultations for patients with headaches and epilepsy than for those with neuromuscular and demyelinating diseases/multiple sclerosis. Furthermore, they agreed that patients' experiences (55.6%) and physicians' acceptance (55.6%) were the two main limitations to implementing virtual clinics. Discussion This study revealed that neurologists were more confident in performing history-taking in virtual clinics than in physical exams. On the contrary, consultants were more confident in handling the physical examination virtually than the neurology residents. Moreover, the most accepted clinics to be handled electronically were the headache and epilepsy clinics in comparison to the other subspecialties, being mainly diagnosed using history. Further studies with larger sample sizes are warranted to observe the level of confidence in performing different duties in neurology virtual clinics.
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Affiliation(s)
- Mohammed Hmoud
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,College of Medicine, University of Bisha, Bisha, Saudi Arabia
| | - Hassan K Salamatullah
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Dania E Faidah
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Seraj Makkawi
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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14
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Abstract
Background The literature for immune-mediated neurological disorders is evolving like no other field of neurological illnesses. Many new antibodies or disorders have been described in the last decade. The cerebellum is a brain structure susceptible to these immune-mediated pathologies, and anti-metabotropic glutamate receptor 1 (mGluR1) antibody has a predilection to the cerebellar tissue. Anti-mGluR1 encephalitis is a rare autoimmune disease affecting the central and peripheral nervous systems, triggering an acute or subacute cerebellar syndrome with varying degrees of severity. Anti-mGluR1 encephalitis is a rare autoimmune disease affecting the central nervous system. We aimed to systematically review reported cases of anti-mGluR1 encephalitis and summarize their clinical presentation, management, outcomes, and case reports. Methods A search of the PubMed and Google Scholar databases was conducted and included all cases of anti-mGluR1 encephalitis published in English before October 1, 2022. A comprehensive systematic review was conducted using "metabotropic glutamate receptor type 1," "mGluR1," autoantibodies," "autoantibodies," "autoimmunity," and "antibody" as keywords. The risk of bias assessment of the evidence was performed using appropriate tools. The qualitative variables were presented as frequency and percentage. Results Including our case, 36 cases of anti-mGluR1 encephalitis (19 males, median age 52.5 years, 11.1% pediatric cases) have been reported. The most common clinical manifestations are ataxia, dysarthria, and nystagmus. Initial imaging was normal in 44.4% of patients; however, 75% of patients showed abnormality later in the disease course. The first-line therapy options include glucocorticoids, intravenous immunoglobulin, and plasma exchange. Rituximab is the most commonly used second-line treatment. Complete remission was achieved in only 22.2% of patients, and 61.8% were disabled by the end of their course. Conclusion Anti-mGluR1 encephalitis manifests as symptoms of cerebellar pathology. Although the natural history has not been completely elucidated, early diagnosis with prompt initiation of immunotherapy could be imperative. Any patient suspected to have autoimmune cerebellitis should be tested for the presence of anti-mGluR1 antibody in the serum and cerebrospinal fluid. Escalation to an aggressive therapy approach should be applied in cases that do not respond to first-line therapies, and extended follow-up durations are required in all cases.
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Affiliation(s)
- Osama Khojah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Saeed Alghamdi
- Neuroscience Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- *Correspondence: Saeed Alghamdi,
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15
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Craner M, Al Malik Y, Babtain FA, Alshamrani F, Alkhawajah MM, Alfugham N, Al-Yafeai RH, Aljarallah S, Makkawi S, Qureshi S, Ziehn M, Wahba H. Unmet Needs and Treatment of Relapsing-Remitting Multiple Sclerosis in Saudi Arabia: Focus on the Role of Ofatumumab. Neurol Ther 2022; 11:1457-1473. [PMID: 36048334 PMCID: PMC9434517 DOI: 10.1007/s40120-022-00401-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/17/2022] [Indexed: 12/13/2022] Open
Abstract
Treatment-pattern data suggest that some patients with multiple sclerosis (MS) in the Kingdom of Saudi Arabia (KSA) may not be receiving optimal treatment. A virtual meeting of ten expert Saudi neurologists, held on October 23, 2020, discussed unmet needs in relapsing-remitting MS (RRMS), and the role of ofatumumab as a suitable treatment in the KSA. Multiple unmet needs were identified: poor quality of life, with high rates of depression and anxiety; a negative impact of MS on work ability; treatment choices that may compromise efficacy for safety or vice versa; inconvenient or complex dosage regimens; and limited access to patient education and support. Early use of highly effective disease-modifying treatments (DMTs) results in better patient outcomes than starting with less effective treatments and downstream escalation, but this strategy may be underutilized in the KSA. B cells are important in MS pathogenesis, and treatments targeting these may improve clinical outcomes. Ofatumumab differs from other B cell-depleting therapies, being a fully human monoclonal antibody that binds to CD20 at a completely separate site from the epitope bound by ocrelizumab, and being administered by subcutaneous injection. When compared with teriflunomide in two randomized, phase 3 clinical trials in patients with RRMS, ofatumumab was associated with significant reductions in annualized relapse rates, rates of confirmed disability worsening, and active lesions on magnetic resonance imaging. The incidence of adverse events, including serious infections, was similar with the two treatments. Ofatumumab is a valuable first- or second-line treatment option for RRMS in the KSA, particularly for patients who would benefit from highly effective DMTs early in the disease course, and for those who prefer the convenience of self-injection. Future research will clarify the position of ofatumumab in RRMS treatment, and comparative cost data may support the broad inclusion of ofatumumab in formularies across the KSA.
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Affiliation(s)
- Matthew Craner
- grid.4991.50000 0004 1936 8948Neurosciences Department, University of Oxford, Oxford, UK
| | - Yaser Al Malik
- grid.412149.b0000 0004 0608 0662College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia ,grid.452607.20000 0004 0580 0891King Abdullah International Medical Research Center, Riyadh, Saudi Arabia ,grid.415254.30000 0004 1790 7311Division of Neurology, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Fawzi A. Babtain
- grid.415310.20000 0001 2191 4301King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Foziah Alshamrani
- grid.411975.f0000 0004 0607 035XDepartment of Neurology, College of Medicine, Imam Abdulrahman bin Faisal University, Al Khobar, Saudi Arabia
| | - Mona M. Alkhawajah
- grid.415310.20000 0001 2191 4301King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Nora Alfugham
- grid.415310.20000 0001 2191 4301King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Salman Aljarallah
- grid.56302.320000 0004 1773 5396College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Seraj Makkawi
- grid.412149.b0000 0004 0608 0662College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia ,grid.452607.20000 0004 0580 0891King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia ,Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | | | - Marina Ziehn
- grid.419481.10000 0001 1515 9979Global Medical Affairs, Novartis AG, Basel, Switzerland
| | - Hazem Wahba
- Medical Affairs/Real World Evidence, Novartis, Saudi Arabia ,Novartis Saudi Ltd., SERVCORP Laysen Valley, Building No. 13, Intersection King Khalid and Orouba Road, Riyadh, Saudi Arabia
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Abuzinadah AR, Almalki AK, Almuteeri RZ, Althalabi RH, Sahli HA, Hayash FA, Alrayiqi RH, Makkawi S, Maglan A, Alamoudi LO, Alamri NM, Alsaati MH, Alshareef AA, Aljereish SS, Bamaga AK, Alhejaili F, Abulaban AA, Alanazy MH. Utility of Initial Arterial Blood Gas in Neuromuscular versus Non-Neuromuscular Acute Respiratory Failure in Intensive Care Unit Patients. J Clin Med 2022; 11:jcm11164926. [PMID: 36013163 PMCID: PMC9410118 DOI: 10.3390/jcm11164926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 12/01/2022] Open
Abstract
Background: The arterial blood gas (ABG) parameters of patients admitted to intensive care units (ICUs) with acute neuromuscular respiratory failure (NMRF) and non-NMRF have not been defined or compared in the literature. Methods: We retrospectively collected the initial ABG parameters (pH, PaCO2, PaO2, and HCO3) of patients admitted to ICUs with acute respiratory failure. We compared ABG parameter ranges and the prevalence of abnormalities in NMRF versus non-NMRF and its categories, including primary pulmonary disease (PPD) (chronic obstructive pulmonary disease, asthma, and bronchiectasis), pneumonia, and pulmonary edema. Results: We included 287 patients (NMRF, n = 69; non-NMRF, n = 218). The difference between NMRF and non-NMRF included the median (interquartile range (IQR)) of pH (7.39 (7.32−7.43), 7.33 (7.22−7.39), p < 0.001), PaO2 (86.9 (71.4−123), 79.6 (64.6−99.1) mmHg, p = 0.02), and HCO3 (24.85 (22.9−27.8), 23.4 (19.4−26.8) mmol/L, p = 0.006). We found differences in the median of PaCO2 in NMRF (41.5 mmHg) versus PPD (63.3 mmHg), PaO2 in NMRF (86.9 mmHg) versus pneumonia (74.3 mmHg), and HCO3 in NMRF (24.8 mmol/L) versus pulmonary edema (20.9 mmol/L) (all p < 0.01). NMRF compared to non-NMRF patients had a lower frequency of hypercarbia (24.6% versus 39.9%) and hypoxia (33.8% versus 50.5%) (all p < 0.05). NMRF compared to PPD patients had lower frequency of combined hypoxia and hypercarbia (13.2% versus 37.8%) but more frequently isolated high bicarbonate (33.8% versus 8.9%) (all p < 0.001). Conclusions: The ranges of ABG changes in NMRF patients differed from those of non-NMRF patients, with a greater reduction in PaO2 in non-NMRF than in NMRF patients. Combined hypoxemia and hypercarbia were most frequent in PPD patients, whereas isolated high bicarbonate was most frequent in NMRF patients.
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Affiliation(s)
- Ahmad R. Abuzinadah
- Neurology Division, Internal Medicine Department, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Neuromuscular Medicine Unit, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Correspondence: ; Tel.: +966-555987830; Fax: +966-126400855
| | | | | | | | | | | | | | - Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah 22384, Saudi Arabia
| | - Alaa Maglan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia
| | - Loujen O. Alamoudi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia
| | - Noof M. Alamri
- Neurology Division, Department of Medicine, Ministry of the National Guard-Health Affairs, Riyadh 11426, Saudi Arabia
| | - Maha H. Alsaati
- Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Aysha A. Alshareef
- Neurology Division, Internal Medicine Department, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Neuromuscular Medicine Unit, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Sultan Saeed Aljereish
- Department of Internal Medicine, King Saud University Medical City, College of Medicine, King Saud University, Riyadh 11472, Saudi Arabia
| | - Ahmed K. Bamaga
- Neurology Division, Pediatric Department, King Abdulaziz University Hospital, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Faris Alhejaili
- Pulmonology Division, Internal Medicine Department, King Abdulaziz University Hospital, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ahmad Abdulaziz Abulaban
- Neurology Division, Department of Medicine, Ministry of the National Guard-Health Affairs, Riyadh 11426, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11426, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia
| | - Mohammed H. Alanazy
- Department of Internal Medicine, King Saud University Medical City, College of Medicine, King Saud University, Riyadh 11472, Saudi Arabia
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Alharbi AR, Alali AS, Samman Y, Alghamdi NA, Albaradie O, Almaghrabi M, Makkawi S, Alghamdi S, Alzahrani MS, Alsalmi M, Karamyan VT, Al Sulaiman K, Aljuhani O, Alamri FF. Vitamin D serum level predicts stroke clinical severity, functional independence, and disability—A retrospective cohort study. Front Neurosci 2022; 16:951283. [PMID: 35968390 PMCID: PMC9363625 DOI: 10.3389/fnins.2022.951283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundStroke is a leading cause of mortality and disability and one of the most common neurological conditions globally. Many studies focused on vitamin D as a stroke risk factor, but only a few focused on its serum level as a predictor of stroke initial clinical severity and recovery with inconsistent results. The purpose of this study was to assess the relationship between serum vitamin D levels and stroke clinical severity at admission and functional independence and disability at discharge in Saudi Arabia.MethodologyA retrospective cohort study of adult ischemic stroke patients who had their vitamin D tested and admitted within 7 days of exhibiting stroke symptoms at King Abdulaziz Medical City (KAMC) Jeddah, Saudi Arabia. Based on vitamin D level, the patients were categorized into normal [25(OH)D serum level ≥ 75 nmol/L], insufficient [25(OH)D serum level is 50–75 nmol/L], and deficient [25(OH)D serum level ≤ 50 nmol/L]. The primary outcome was to assess the vitamin D serum level of ischemic stroke patients’ clinical severity at admission and functional independence at discharge. The National Institute of Health Stroke Scale (NIHSS) was used to assess the clinical severity, whereas the modified Rankin scale (mRS) was used to assess functional independence and disability.ResultsThe study included 294 stroke patients, out of 774, who were selected based on the inclusion and exclusion criteria. The mean age of the participants was 68.2 ± 13.4 years, and 49.3% were male. The patients’ distribution among the three groups based on their vitamin D levels is: normal (n = 35, 11.9%), insufficient (n = 66, 22.5%), and deficient (n = 196, 65.6%). After adjusting for potential covariates, regression analysis found a significant inverse relationship of NIHSS based on 25(OH)D serum level (beta coefficient: −0.04, SE: 0.01, p = 0.003). Patients with deficient serum vitamin D level also had significantly higher odds of worse functional independence in mRS score [OR: 2.41, 95%CI: (1.13–5.16), p = 0.023] when compared to participants with normal vitamin D level.ConclusionLow vitamin D levels were associated with higher severity of stroke at admission and poor functional independence and disability at discharge in patients with acute ischemic stroke. Further randomized clinical and interventional studies are required to confirm our findings.
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Affiliation(s)
- Abdullah R. Alharbi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Amer S. Alali
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Yahya Samman
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Basic Sciences, College of Science and Health Professions (KSAU-HS), King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Nouf A. Alghamdi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Medicine, College of Medicine, Al-Baha University, Al-Baha, Saudi Arabia
| | - Omar Albaradie
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Basic Sciences, College of Science and Health Professions (KSAU-HS), King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Maan Almaghrabi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Seraj Makkawi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Saeed Alghamdi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Mohammad S. Alzahrani
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Mohammed Alsalmi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Vardan T. Karamyan
- Department of Pharmaceutical Sciences, Jerry. H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX, United States
- Center for Blood Brain Barrier Research, Jerry. H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX, United States
| | - Khalid Al Sulaiman
- Department of Pharmaceutical Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Saudi Critical Care Pharmacy Research (SCAPE) Platform, Riyadh, Saudi Arabia
| | - Ohoud Aljuhani
- Department of Pharmacy Practice, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faisal F. Alamri
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Basic Sciences, College of Science and Health Professions (KSAU-HS), King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Salman Center for Disability Research, Riyadh, Saudi Arabia
- *Correspondence: Faisal F. Alamri,
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18
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Makkawi S, Aljabri A, Bin Lajdam G, Albakistani A, Aljohani A, Labban S, Felemban R. Effect of Seasonal Variation on Relapse Rate in Patients With Relapsing-Remitting Multiple Sclerosis in Saudi Arabia. Front Neurol 2022; 13:862120. [PMID: 35359633 PMCID: PMC8964008 DOI: 10.3389/fneur.2022.862120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple sclerosis (MS) is becoming a global subject of study in which some demographic variations are thought to be correlated with its activity. Relapsing-remitting multiple sclerosis (RRMS) is the most common demyelinating disorder, characterized by periods of exacerbating attacks, followed by partial or complete remission. Several factors might play a role in disease progression and relapse frequency, such as vitamin D, ultraviolet B radiation, estrogen levels, smoking, obesity, and unhealthy lifestyles. In this study, we identified the relationship between seasonal variation and relapse rate and correlated the latter with sex, age, and vitamin D levels in patients with RRMS in Jeddah, Saudi Arabia. We retrospectively collected data from 182 RRMS patients between 2016 and 2021. A total of 219 relapses were documented in 106 patients (58.2 %). The relapse per patient ratio showed a sinusoidal pattern, peaking in January at a rate of 0.49 and troughed in June at a rate of 0.18. There was no difference in relapse rates between men and women (p =0.280). There was a significant negative correlation between vitamin D levels and relapse rate (r = −0.312, p =0.024). Therefore, the relapse rate was higher during the winter and was correlated with low vitamin D levels. However, relapses are likely multifactorial, and more population-based studies are needed to understand the role of environmental variables in MS exacerbation. A better understanding of this relationship will allow for improved treatment and possibly better prevention of relapse.
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Affiliation(s)
- Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Ammar Aljabri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ghassan Bin Lajdam
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ammar Albakistani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdulrahman Aljohani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Suhail Labban
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Razaz Felemban
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
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19
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Makkawi S, AlHarbi FA, Alsulaimani N, Brashi R, Melebary R, Aljabri S, Altowairqi KF, Ashoor AF, Alkhotani A. The Relationship Between Smoking and Multiple Sclerosis Severity in Saudi Arabia. Cureus 2022; 14:e24181. [PMID: 35592196 PMCID: PMC9110077 DOI: 10.7759/cureus.24181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction Multiple sclerosis (MS) is an autoimmune disease that can be disabling to patients. Smoking has been proposed to be a risk factor for MS and to increase the risk of progression of the disease and its severity. However, it is still not clear how smoking affects people with MS (PwMS) regarding disease phenotype, symptoms, relapses, course, and disability. The aim of this study is to investigate the effect of smoking on PwMS in Saudi Arabia. Methods This is an online questionnaire-based cross-sectional study. PwMS were randomly contacted through different MS societies and associations to participate in the study. The questionnaire inquired about demographics, MS phenotype and severity, and smoking status of the participants. Data were collected between May 30, 2021, and July 5, 2021. Results Four hundred twenty-nine PwMS participated in the study. The mean age was 33.7, with a mean disease duration of 8.1 years. About 61.1% of the participants were female. About 62.2% did not know the specific MS phenotype they have. About 35.7% were current or previous smokers, with a mean smoking duration of 13.9 years. Smoking was significantly associated with the presence of multiple MS symptoms (p-value = 0.009) and their number (p-value = 0.050). In addition, there was a significant positive correlation between pack-years smoking and the number of MS symptoms with a Pearson's r value of 0.165 (p-value = 0.001). No significant associations were found between smoking and recent relapses and disease progression, disability in terms of walking, needing a cane, or needing a wheelchair. Conclusion Smoking was shown to have a significant effect on the number of symptoms experienced by PwMS. Higher pack-years of smoking correlates positively and significantly with a higher number of MS symptoms. Further studies to examine these relations are hence warranted.
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Affiliation(s)
- Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
- Department of Medicine, Ministry of National Guard Health Affairs, Jeddah, SAU
| | - Fahad A AlHarbi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Nedaa Alsulaimani
- Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Reem Brashi
- Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Renad Melebary
- Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Shuaa Aljabri
- Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Khalid F Altowairqi
- Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Albaraa F Ashoor
- Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Amal Alkhotani
- Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
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20
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Makkawi S, Alqarni AA, Alghaythee H, Alharbi SY, Fatani A, Adas R, Abuzinadah AR. Atypical Familial Amyotrophic Lateral Sclerosis Secondary to Superoxide Dismutase 1 Gene Mutation With Coexistent Axonal Polyneuropathy: A Challenging Diagnosis. Cureus 2022; 14:e20989. [PMID: 35154965 PMCID: PMC8817726 DOI: 10.7759/cureus.20989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/05/2022] Open
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21
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AlHarbi FA, Alomari MS, Ghaddaf AA, Abdulhamid AS, Alsharef JF, Makkawi S. Public awareness and attitudes toward epilepsy in Saudi Arabia: A systematic review and meta-analysis. Epilepsy Behav 2021; 124:108314. [PMID: 34592634 DOI: 10.1016/j.yebeh.2021.108314] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/29/2021] [Accepted: 08/29/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Public awareness of epilepsy and attitudes toward people with epilepsy (PWE) largely affect patients' perceived stigma and their quality of life. Educational interventions to increase public awareness of the disease need to target areas of lowest awareness levels to achieve best results. The aim of this review was to identify these areas in Saudi Arabia. METHODS This review was based on PRISMA guidelines. Medline, PsychInfo, Embase, Ovid Evidence-Based Medicine Reviews, and Web of Science databases were searched for relevant literature. Inclusion criteria was cross-sectional studies that are done in Saudi Arabia, assess any aspect of epilepsy awareness or attitudes toward PWE, and report outcomes in proportions. Meta-analysis was done on outcomes reported in ≥5 studies utilizing random-effects model. Quality assessment was done using AXIS tool. RESULTS Twenty-seven studies were included in this review. A total of 48 questions' outcomes were reported in ≥3 studies, and 26 of them were included in the meta-analysis. The meta-analysis estimated that 6.4% (CI 4.2-9.7%) of the population think epilepsy is a contagious disease; 90.7% (CI 85.5-94.1%) have heard/read about epilepsy; 53.1% (CI 47.7-58.3%) have witnessed a seizure; 38.6% (CI 24.7-54.7%) think epilepsy is a psychological disorder; 25.2% (CI 16.5-36.7%) think it is caused by spirit possession; 35.1% (CI 22.0-50.8%) were estimated to think it is caused by evil eye (envy); 37.9% (CI 21.9-57.0%) would try to put something inside a seizing patient's mouth to prevent tongue biting; 34.6% (CI 26.9-43.1%) would approve their offspring marrying someone with epilepsy. CONCLUSION Areas of unsatisfactory awareness levels included etiology of epilepsy and appropriate seizure responses. Attitudes were more negative regarding marriage, children, and employment. These areas need to be properly addressed in future educational interventions.
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Affiliation(s)
- Fahad A AlHarbi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
| | - Mohammed S Alomari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdullah A Ghaddaf
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed S Abdulhamid
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Jawaher F Alsharef
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
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22
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Alanazy MH, Bakry SS, Alqahtani A, AlAkeel NS, Alazwary N, Osman AM, Mustafa RA, Al-Harbi TM, Abdulmana SO, Amper AC, Aldughaythir Y, Ali AS, Makkawi S, Maglan A, Alamoudi L, Alsulaiman F, Alabdali M, AlShareef AA, Abuzinadah AR, Bamaga AK. Clinical features and outcome of Guillain-Barre syndrome in Saudi Arabia: a multicenter, retrospective study. BMC Neurol 2021; 21:275. [PMID: 34253174 PMCID: PMC8273933 DOI: 10.1186/s12883-021-02314-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/30/2021] [Indexed: 01/16/2023] Open
Abstract
Background Guillain–Barre syndrome (GBS) is an inflammatory polyradiculoneuropathy characterized by rapidly evolving weakness and areflexia, reaching nadir within 4 weeks. Data on the characteristic of GBS in Saudi Arabia are limited. This study aimed to describe the clinical, electrophysiological, and laboratory characteristics and outcome of a multicenter cohort of patients with GBS. Methods This is a retrospective multicenter nationwide study. Patients who had GBS, identified through Brighton Criteria, between January 2015 and December 2019 were included. Data collected included demographics, clinical features, cerebrospinal fluid profile, reported electrophysiological patterns, treatment, and outcome. Reported GBS subtypes were compared using chi-square, Fisher's exact, or Mann–Whitney U tests, as appropriate. Results A total of 156 patients with GBS were included (men, 61.5%), with a median age of 38 (interquartile range, 26.25–53.5) years. The most commonly reported antecedent illnesses were upper respiratory tract infection (39.1%) and diarrhea (27.8%). All but two patients (98.7%) had weakness, 64.1% had sensory symptoms, 43.1% had facial diplegia, 33.8% had oropharyngeal weakness, 12.4% had ophthalmoplegia, and 26.3% needed mechanical ventilation. Cytoalbuminological dissociation was observed in 69.1% of the patients. GBS-specific therapy was administered in 96.8% of the patients, of whom 88.1% had intravenous immunoglobulin, and 11.9% had plasmapheresis. Approximately half of the patients were able to walk independently within 9 months after discharge, and a third regained the ability to walk independently thereafter. Death of one patient was caused by septicemia. Acute inflammatory demyelinating polyradiculoneuropathy was the most commonly reported GBS subtype (37.7%), followed by acute motor axonal neuropathy (29.5%), and acute motor-sensory axonal neuropathy (19.2%). Conclusion The clinical and laboratory characteristics and outcome of GBS in the Arab population of Saudi Arabia are similar to the international cohorts. The overall prognosis is favorable.
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Affiliation(s)
- Mohammed H Alanazy
- Division of Neurology, Department of Internal Medicine, King Saud University Medical City and College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Sawsan S Bakry
- Division of Neurology, Department of Internal Medicine, King Saud University Medical City and College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Afnan Alqahtani
- Division of Neurology, Department of Internal Medicine, King Saud University Medical City and College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Norah S AlAkeel
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Naael Alazwary
- Department of Medicine, Security Forces Hospital Program, Riyadh, Saudi Arabia
| | - Afag M Osman
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Rania A Mustafa
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Talal M Al-Harbi
- Neurology Department, Neuroscience Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Sameeh O Abdulmana
- Neurology Department, Neuroscience Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Aimee C Amper
- Neurology Department, Neuroscience Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Yousef Aldughaythir
- Neurology Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman S Ali
- Neurology Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Alaa Maglan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Loujen Alamoudi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Feras Alsulaiman
- Department of Neurology, King Fahad Hospital of the University, Imam Abdulrhman Bin Faisal University, Dammam, Saudi Arabia
| | - Majed Alabdali
- Department of Neurology, King Fahad Hospital of the University, Imam Abdulrhman Bin Faisal University, Dammam, Saudi Arabia
| | - Aysha A AlShareef
- Internal Medicine Department, Neurology Division, Neuromuscular Medicine Unit, Faculty of Medicine and King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad R Abuzinadah
- Internal Medicine Department, Neurology Division, Neuromuscular Medicine Unit, Faculty of Medicine and King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed K Bamaga
- Pediatric department, Neuromuscular Medicine Unit, Faculty of Medicine and King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
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23
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Alshamrani F, Alnajashi H, AlJumah M, Almuaigel M, Almalik Y, Makkawi S, Alsalman S, Almejally M, Qureshi S, Aljarallah S, AlKhawajah N, Kedah H, Alotaibi H, Saeedi J, Alamri A. Registry of patients with multiple sclerosis and COVID-19 infection in Saudi Arabia. Mult Scler Relat Disord 2021; 52:103004. [PMID: 34049217 PMCID: PMC8103739 DOI: 10.1016/j.msard.2021.103004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/13/2021] [Accepted: 04/29/2021] [Indexed: 01/15/2023]
Abstract
Background The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread and developed as a pandemic threatening global health. Patients with multiple sclerosis (MS)–an autoimmune demyelinating inflammatory disease of the central nervous system (CNS)–are predominantly treated with immunomodulatory/immunosuppressive disease-modifying therapies (DMTs), which can increase the risk of infection. Therefore, there is concern that these patients may have a higher risk of COVID-19. In response to growing concerns of neurologists and patients, this study aimed to determine the prevalence, severity, and possible complications of COVID-19 infection in patients with MS in Saudi Arabia (SA). Methods In this prospective cohort study, demographic and clinical data were obtained from patients residing in SA with MS who had a positive result for COVID-19 per reverse transcription-polymerase chain reaction test or viral gene sequencing, using respiratory or plasma samples. Comparison of COVID-19 severity groups was performed using one-way ANOVA or Kruskal-Wallis test for numerical variables and Chi-squared test for categorical variables. Results Seventy patients with MS and COVID-19 (71% female) were included in this analysis. Of the 53 (75.7%) patients receiving a DMT at the time of COVID-19 infection, the most frequently used DMTs were fingolimod (25%) and interferon-beta (25%). Nine (13%) patients had MS relapse and were treated with intravenous methylprednisolone in the four weeks before COVID-19 infection. The most common symptoms at the peak of COVID-19 infection were fever (46%), fatigue (37%), and headache (36%). Symptoms lasted for a mean duration of 8.7 days; all symptomatic patients recovered and no deaths were reported. COVID-19 severity was categorized in three groups: asymptomatic (n = 12), mild–not requiring hospitalization (n = 48), and requiring hospitalization (n = 10; two of whom were admitted to the intensive care unit [ICU]). Between the three groups, comparison of age, body mass index , Expanded Disability Severity Score , MS disease duration, and DMT use at the time of infection showed no significant differences. A higher percentage of patients who were admitted to hospital or the ICU (40%; p = 0.026) presented with an MS relapse within the prior four weeks compared with those who were asymptomatic or had a mild infection (both 8.3%). Conclusion These findings present a reassuring picture regarding COVID-19 infection in patients with MS. However, patients with MS who have had a relapse in the preceding four weeks (requiring glucocorticoid treatment) may have an increased risk of severe COVID-19.
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Affiliation(s)
- Foziah Alshamrani
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | | | | | - Mohammad Almuaigel
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yaser Almalik
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | | | | | | | | | | | | | | | - Jameelah Saeedi
- King Abdullah Abdulla Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Abdulla Alamri
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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24
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Albassam MS, Thabet SA, Hmoud M, Makkawi S. Anti-Muscle Specific Kinase (Anti-MuSK) Positive Myasthenia Gravis Overlapping With Parkinson's Disease: A Challenging Diagnosis. Cureus 2021; 13:e14839. [PMID: 34104586 PMCID: PMC8174120 DOI: 10.7759/cureus.14839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The concomitance between Parkinson's disease (PD) and myasthenia gravis (MG) is rare, with only a few case reports in the literature and only one of them with positive anti-muscle specific kinase (anti-MuSK) MG. The overlap between PD and MG symptoms can cause a diagnostic dilemma for the treating physician. In this report, we present a 73-year-old lady with a history of recurrent falls, dysphagia, and diplopia. She was found to have ptosis, vertical gaze restriction, neck extension, and flexion weakness, as well as features of parkinsonism, including masked face appearance, asymmetrical limbs rigidity, and bradykinesia. She was found to have a high titer antibody for MuSK MG. Her MG symptoms were treated successfully with rituximab.
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Affiliation(s)
- Mohammed S Albassam
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Salman A Thabet
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Mohammed Hmoud
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, SAU.,College of Medicine, University of Bisha, Bisha, SAU
| | - Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.,Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU.,Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, SAU
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25
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Abstract
Combined central and peripheral demyelination (CCPD) is a rare disorder characterized by demyelinating lesions in both the central and peripheral nervous systems. The following case report is of a 29-year-old man who presented with a three-month history of progressive lower and upper limb weakness associated with facial and arm tremor, as well as urinary hesitancy. Brain and spine magnetic resonance imaging showed multiple demyelinating plaques. Nerve conduction studies revealed evidence of demyelination with severe prolongation of distal motor latencies and reduced conduction velocities. The patient received plasmapheresis and high-dose corticosteroids, which lead to clinical improvement. A rituximab infusion protocol was subsequently started, and the patient received two cycles. There was a significant functional improvement upon the use of rituximab. This study reports a rare neurological disease entity and highlights the necessity for conducting larger studies to optimally demonstrate the efficacy of rituximab in CCPD.
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Affiliation(s)
- Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.,Medicine, King Abdullah International Medical Research Center, Jeddah, SAU.,Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, SAU
| | - Faisal Yonbawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Yousef Qari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Morad Aljinaid
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, SAU
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26
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Al Jumah M, Abulaban A, Aggad H, Al Bunyan R, AlKhawajah M, Al Malik Y, Almejally M, Alnajashi H, Alshamrani F, Bohlega S, Cupler EJ, ElBoghdady A, Makkawi S, Qureshi S, Shami S. Managing multiple sclerosis in the Covid19 era: a review of the literature and consensus report from a panel of experts in Saudi Arabia. Mult Scler Relat Disord 2021; 51:102925. [PMID: 33857897 PMCID: PMC7992311 DOI: 10.1016/j.msard.2021.102925] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/10/2021] [Accepted: 03/21/2021] [Indexed: 12/17/2022]
Abstract
Disease-modifying therapies (DMT) for relapsing-remitting MS (RRMS) act on the immune system, suggesting a need for caution during the SARS-CoV2/Covid-19 pandemic. A group of experts in MS care from Saudi Arabia convened to consider the impact of Covid-19 on MS care in that country, and to develop consensus recommendations on the current application of DMT therapy. Covid-19 has led to disruption to the care of MS in Saudi Arabia as elsewhere. The Expert Panel considered a DMT's overall tolerability/safety profile to be the most important consideration on whether or not to prescribe at this time. Treatment can be started or continued with interferon beta, teriflunomide, dimethyl fumarate, or natalizumab, as these DMTs are not associated with increased risk of infection (there was no consensus on the initiation of other DMTs). A consensus also supported continuing treatment regimens with fingolimod (or siponimod) and cladribine tablets for a patient without active Covid-19. No DMT should be imitated in a patient with active Covid-19, and (only) interferon beta could be continued in the case of Covid-19 infection. Vaccination against Covid-19 is a therapeutic priority for people with MS. New treatment should be delayed for 2–4 weeks for vaccination. Where treatment is already ongoing, vaccination against Covid-19 should be administered immediately without disruption of treatment (first-line DMTs, natalizumab, fingolimod), when lymphocytes have recovered sufficiently (cladribine tablets, alemtuzumab) or 4 months after the last dose (ocrelizumab). These recommendations will need to be refined and updated as new clinical evidence in this area emerges.
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Affiliation(s)
- Mohammed Al Jumah
- Neurology Department, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Ahmad Abulaban
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Medicine, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hani Aggad
- Neurology Department, King Abdallah Medical Complex, Jeddah, Saudi Arabia
| | - Reem Al Bunyan
- Department of Neurology, Neurosciences Center, King Fahad Specialist Hospital Dammam, Saudi Arabia
| | - Mona AlKhawajah
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Riyadh Saudi Arabia
| | - Yaser Al Malik
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Division of Neurology, King Abdulaziz Medical City (National Guard Health Affairs), Riyadh, Saudi Arabia
| | - Mousa Almejally
- Neurology Department, Heraa General Hospital, Makkah, Saudi Arabia
| | - Hind Alnajashi
- Neurology Division, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Saeed Bohlega
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah Saudi Arabia
| | - Edward J Cupler
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah Saudi Arabia
| | - Ahmed ElBoghdady
- Merck Serono Middle East FZ LTD, Riyadh, Saudi Arabia, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Shireen Qureshi
- Neurology Department, Johns Hopkins Aramco Healthcare (JHAH), Dhahran, Saudi Arabia
| | - Sahar Shami
- Itkan Health Consulting, Riyadh, Saudi Arabia
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27
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Algahtani H, Shirah B, Ibrahim B, Malik YA, Makkawi S. Clinical and Radiological Characteristics of Neuromyelitis Optica Spectrum Disorder: The Experience from Saudi Arabia. Mult Scler Relat Disord 2020; 47:102668. [PMID: 33307475 DOI: 10.1016/j.msard.2020.102668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/24/2020] [Accepted: 11/28/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune astrocytopathy that affects several regions of the central nervous system (CNS) with a predilection for the optic nerves and spinal cord. Epidemiological studies of NMOSD are uncommon in the Middle East and up-to-date, there are no such data from Saudi Arabia. In this study, we aim to study the clinical pattern of NMOSD patients in Saudi Arabia. METHODS A retrospective multi-center observational study was conducted at King Abdulaziz Medical City in Jeddah and Riyadh, Saudi Arabia. The inclusion criteria consisted of all the patients with either neuromyelitis optica according to the 2006 criteria or NMOSD according to the 2015 criteria. The study period was 20 years. RESULTS A total of 23 patients were included in the study. Four were males (17.4%) and 19 were females (82.6%). The attack type was optic neuritis in 3 patients (13.0%), transverse myelitis in 15 patients (65.2%), and both in 5 patients (21.7%). All patients (100%) received pulse steroid therapy (intravenous methylprednisolone 1 g for 5 days) at the onset of the disease. Fifteen patients had plasma exchange therapy (65.2%). All patients received maintenance immunosuppressive treatment except 1 (4.3%). CONCLUSION NMOSD is a rare, broad-spectrum, polyphasic, rare disorder primarily affecting the optic pathway and the spinal cord either in isolation or simultaneously. Unfortunately, there are no adequate studies that assess NMOSD cohorts in Saudi Arabia despite the increased number of diagnosed cases. In addition, there is no registry for this disorder with only a few specialized centers dealing with its management. It is time to establish specialized demyelinating disease centers and build expertise in both common and rare diseases in this category.
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Affiliation(s)
- Hussein Algahtani
- King Abdulaziz Medical City/ King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
| | - Bader Shirah
- King Abdullah International Medical Research Center / King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Badr Ibrahim
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Yaser Al Malik
- King Saud bin Abdulaziz University for Health Sciences / King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Seraj Makkawi
- King Abdulaziz Medical City/ King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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28
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Makkawi S, Camara-Lemarroy C, Metz L. Fecal microbiota transplantation associated with 10 years of stability in a patient with SPMS. Neurol Neuroimmunol Neuroinflamm 2018; 5:e459. [PMID: 29619403 PMCID: PMC5882466 DOI: 10.1212/nxi.0000000000000459] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/28/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Seraj Makkawi
- Department of Clinical Neurosciences (S.M., C.C.-L., L.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and King Saud Bin Abdulaziz University for Health Sciences (S.M.), Jeddah, Saudi Arabia
| | - Carlos Camara-Lemarroy
- Department of Clinical Neurosciences (S.M., C.C.-L., L.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and King Saud Bin Abdulaziz University for Health Sciences (S.M.), Jeddah, Saudi Arabia
| | - Luanne Metz
- Department of Clinical Neurosciences (S.M., C.C.-L., L.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and King Saud Bin Abdulaziz University for Health Sciences (S.M.), Jeddah, Saudi Arabia
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