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Alsaadi T, Kayed DM, Al-Madani A, Hassan AM, Krieger D, Riachi N, Sarathchandran P, Al-Rukn S. Acute Treatment of Migraine: Expert Consensus Statements from the United Arab Emirates (UAE). Neurol Ther 2024; 13:257-281. [PMID: 38240944 PMCID: PMC10951165 DOI: 10.1007/s40120-023-00576-4] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/22/2023] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION Migraine, characterized by recurrent headaches and often accompanied by other symptoms like nausea, vomiting, and sensitivity to light and sound, significantly impacts patients' quality of life (QoL) and daily functioning. The global burden of migraines is reflected not only in terms of reduced QoL but also in the form of increased healthcare costs and missed work or school days. While UAE (United Arab Emirates)-specific consensus-based recommendations for the effective use of preventive calcitonin gene-related peptide (CGRP)-based migraine therapies have been published previously, an absence of such regional guidance on the management of acute migraine represents a gap that needs to be urgently addressed. METHODS A task force of eight neurologists from the UAE with expertise in migraine management conducted a comprehensive literature search and developed a set of expert statements on the management of acute migraine that were specific to the UAE context. To ensure diverse perspectives are considered, a Delphi panel comprising 16 neurologists plus the task force members was set up. Consensus was achieved using a modified Delphi survey method. Consensus was predefined as a median rating of 7 or higher without discordance (if > 25% of the Delphi panelists rate an expert statement as 3 or lower on the Likert scale). Expert statements achieving consensus were adopted. RESULTS The Modified Delphi method was used successfully to achieve consensus on all nine expert statements drafted by the task force. These consensus statements aim to provide a comprehensive guide for UAE healthcare professionals in treating acute migraine. The statements cover all aspects of acute migraine treatment, including what goals to set, the timing of treatment, treatment strategy to use in case of inadequate response to triptans, safety aspects of combining gepants for acute attacks with preventive CGRP-based therapies, special population (pregnant and pediatric patients) considerations, and the management of the most bothersome symptoms (MBS). CONCLUSIONS Adopting these consensus statements on the treatment of acute migraine can help enhance patient care, improve outcomes, and standardize treatment practices in the UAE. The collaborative effort of experts with diverse experiences in developing these consensus statements will strengthen the credibility and applicability of these statements to various healthcare settings in the country.
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Affiliation(s)
- Taoufik Alsaadi
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE.
| | - Deeb M Kayed
- Neurology Department, Mediclinic City Hospital, Dubai, UAE
| | | | | | - Derk Krieger
- NMC Royal at DIP, United Medical Center, Fakeeh University Hospital, Dubai, UAE
| | - Naji Riachi
- Sheikh Shakhbout Medical City, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, UAE
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Alsaadi T, Suliman R, Santos V, Al Qaisi I, Carmina P, Aldaher B, Haddad S, Bader Y. Safety and Tolerability of Combining CGRP Monoclonal Antibodies with Gepants in Patients with Migraine: A Retrospective Study. Neurol Ther 2024; 13:465-473. [PMID: 38361080 PMCID: PMC10951184 DOI: 10.1007/s40120-024-00586-w] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION The introduction of clacitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) has revolutionized the treatment of migraines. In clinical practice gepants might be considered as a valid option to treat acute attacks in patients with migraine who are treated with mAbs. However, the safety and tolerability of such a combination is not well addressed in the real-world setting. We designed this study to evaluate the safety and tolerability of combining CGRP mAbs with gepants in the management of migraines. METHODS This was a retrospective, real-world, exploratory study. The participants included within the study were adult (≥ 18 years) patients diagnosed with migraine. Screening for patients who were treated with at least one GCRP mAbs was done. Data was collected from one site, the American Center for Psychiatry and Neurology, Abu Dhabi UAE. A total of 516 patients taking CGRP mAbs were identified. Extracted data from patients' electronic medical records included patient demographics, migraine characteristics, prescribed treatments, and adverse events (AEs). The tolerability and safety of the combination therapy was evaluated on the basis of documented AEs. RESULTS Among the identified 516 patients, 234 were administered gepants in addition to the CRGP mAb (215, rimegepant; 19, ubrogepant). Eleven of the 234 patients switched from rimegepant to urogepant as a result of lack of efficacy; one patient switched from urogepant to zolmitriptan because of the lack of insurance coverage of the former medication. Among all the patients included in this study, three AEs were documented. These AEs were generally mild and transient and hence did not lead to discontinuation of treatment. Moreover, 42 of the 234 (17.9%) patients were switched from one class of CGRP mAbs to another at least once while continuing treatment with the assigned gepants. CONCLUSION The findings of this study demonstrate that combining CGRP mAbs with gepants is a safe and well-tolerated treatment approach for migraine. Future studies are warranted to further validate these findings and explore long-term outcomes.
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Affiliation(s)
- Taoufik Alsaadi
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE.
| | - Reem Suliman
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE.
| | - Vanessa Santos
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE
| | - Ibrahim Al Qaisi
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE
| | - Princess Carmina
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE
| | - Batool Aldaher
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE
| | - Shadi Haddad
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE
| | - Yazan Bader
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE
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Suliman R, Santos V, Al Qaisi I, Aldaher B, Al Fardan A, Al Barrawy H, Bader Y, Supena JL, Alejandro K, Alsaadi T. Effectiveness of Switching CGRP Monoclonal Antibodies in Non-Responder Patients in the UAE: A Retrospective Study. Neurol Int 2024; 16:274-288. [PMID: 38392960 PMCID: PMC10893254 DOI: 10.3390/neurolint16010019] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) have shown promising effectiveness in migraine management compared to other preventative treatment options. Many questions remain regarding switching between antibody classes as a treatment option in patients with migraine headaches. This preliminary retrospective real-world study explored the treatment response of patients who switched between CGRP mAb classes due to lack of efficacy or poor tolerability. A total of 53 patients with migraine headache switched between three of the CGRP mAbs types due to lack of efficacy of the original prescribed CGRP mAbs, specifically eptinezumab, erenumab, and galcanezumab. Fremanezumab was not included due to unavailability in the UAE. Galcanezumab and eptinezumab target the CGRP ligand (CGRP/L), while erenumab targets CGRP receptors (CGRP/R). The analysis of efficacy demonstrated that some improvements were seen in both class switch cohorts (CGRP/R to CGRP/L and CGRP/L to CGRP/R). The safety of switching between CGRP classes was well observed, as any adverse events presented before the class switch did not lead to the discontinuation of treatment following the later switch. The findings of this study suggest that switching between different classes of CGRP mAbs is a potentially safe and clinically viable practice that may have some applications for those experiencing side effects on their current CGRP mAb or those witnessing suboptimal response.
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Affiliation(s)
- Reem Suliman
- American Center for Psychiatry and Neurology, Abu Dhabi P.O. Box 108699, United Arab Emirates (B.A.)
| | | | | | | | | | | | | | | | | | - Taoufik Alsaadi
- American Center for Psychiatry and Neurology, Abu Dhabi P.O. Box 108699, United Arab Emirates (B.A.)
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Alsaadi T, Kayed DM, Al-Madani A, Hassan AM, Terruzzi A, Krieger D, Riachi N, Sarathchandran P, Al-Rukn S. Consensus-Based Recommendations on the Use of CGRP-Based Therapies for Migraine Prevention in the UAE. Neurol Ther 2023; 12:1845-1865. [PMID: 37792218 PMCID: PMC10630270 DOI: 10.1007/s40120-023-00550-0] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/19/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Migraine is a common debilitating neurological disorder affecting a large proportion of the general population. Calcitonin gene-related peptide (CGRP), a 37-amino acid neuropeptide, plays a key role in the pathophysiology of migraine, and the development of therapies targeting the anti-CGRP pathway has revolutionized the field of migraine treatment. METHODS An expert task force of neurologists in the United Arab Emirates (UAE) developed and critically assessed recommendations on the use of CGRP-based therapies in migraine treatment and management in the UAE, based on available published literature. A consensus was reached for each statement by means of an open-voting process, based on a predefined agreement level of at least 60%. RESULTS The consensus recommendations advocate the need for guidelines for the appropriate use of CGRP-based therapies by defining patient cohorts and appropriate monitoring of therapeutic response as well as standardizing the initiation, assessment, and cessation of treatment. The consensus recommendations were primarily formulated on the basis of international studies, because of the limited availability of regional and local data. As such, they may also act as guidelines for global healthcare providers. CONCLUSIONS These are the first consensus recommendations for the UAE that address the use of CGRP-based therapies in the treatment and management of migraine, integrating both clinical evidence and medical expertise to enhance clinical judgment and decision-making.
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Affiliation(s)
- Taoufik Alsaadi
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE.
| | - Deeb M Kayed
- Neurology Department, Mediclinic City Hospital, Dubai, UAE
| | | | | | | | - Derk Krieger
- Neurology Department, Mediclinic Parkview Hospital, Dubai, UAE
| | - Naji Riachi
- Sheikh Shakhbout Medical City, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, UAE
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Bader Y, Suliman R, Harb M, Santos V, Al Qaisi I, Alsaadi T. Effectiveness and Safety of Eptinezumab in Episodic and Chronic Migraine Headache in the UAE: A Retrospective Study. Neurol Ther 2023; 12:1683-1693. [PMID: 37418120 PMCID: PMC10444733 DOI: 10.1007/s40120-023-00521-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023] Open
Abstract
INTRODUCTION Eptinezumab is a humanized IgG1 immunoglobulin monoclonal antibody administered intravenously as a preventative migraine treatment. Previously conducted randomized, double-blind, placebo-controlled trials exhibited significant reductions in monthly migraine frequency among adults experiencing episodic and chronic migraine. The present study seeks to expand upon the current findings and to evaluate eptinezumab's efficacy as a preventative treatment for chronic and episodic migraine patients in the United Arab Emirates. This study is intended to represent the first real-world evidence and will hopefully serve as a valuable complement to the existing literature on the subject. METHODS This was a retrospective exploratory study. The participants included within the study were adult (≥ 18 years) patients diagnosed with either episodic or chronic migraine. Patients were categorized according to their history of previous preventative treatment failure. For the final assessment of treatment efficacy, we included only patients with a minimum of 6 months of clinical follow-up data. Patients were assessed at baseline for their monthly migraine frequency and assessed again at months 3 and 6. The primary objective was to evaluate the efficacy of eptinezumab in reducing migraine frequency among chronic and episodic migraine patients. RESULTS A total of 100 participants were identified, of whom 53 completed the study protocol at month 6. Of the total, 40 (75.47%) were female, 46 (86.79%) were Emirati locals, and 16 (30.19%) were pharmaceutically naïve, having never tried any prior preventative therapy. Additionally, 25 (47.17%) patients met the criteria for chronic migraine (CM), whereas the remaining 28 (52.83%) were diagnosed with episodic migraine (EM). The baseline monthly migraine frequency (MMD) was 12.23 (4.97) days across all participants, 15.56 (3.97) for CM patients, and 9.25 (3.76) for EM patients; by month 6, these frequencies reduced to 3.66 (4.21), 4.76 (5.32), and 2.68 (2.61), respectively. Overall, 58.49% of those enrolled experienced > 75% reduction in MMD frequency by month 6. CONCLUSION Patients enrolled in this trial experienced clinically significant reductions in MMD by month 6. Eptinezumab was well tolerated and with one AE of significance that led to discontinuation from the study.
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Affiliation(s)
- Yazan Bader
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE
| | - Reem Suliman
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE.
| | - Mohamad Harb
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE
| | - Vanessa Santos
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE
| | - Ibrahim Al Qaisi
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE
| | - Taoufik Alsaadi
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE.
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Inshasi J, Farouk S, Shatila A, Hassan A, Szolics M, Thakre M, Kayed D, Krieger D, Almadani A, Alsaadi T, Benedetti B, Mifsud V, Jacob A, Sayegh S, Boshra A, Alroughani R. Multicentre Observational Study of Treatment Satisfaction with Cladribine Tablets in the Management of Relapsing Multiple Sclerosis in the Arabian Gulf: The CLUE Study. Neurol Ther 2023; 12:1309-1318. [PMID: 37289421 PMCID: PMC10310633 DOI: 10.1007/s40120-023-00497-2] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/10/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Inconvenient administration and side effects of some disease-modifying therapies (DMTs) for relapsing multiple sclerosis (RMS) can deter adherence. We evaluated treatment satisfaction with cladribine tablets (CladT) for RMS in the Arabian Gulf. METHODS This was a non-interventional, multicentre, prospective observational study in non-pregnant/lactating adults (aged ≥ 18 years) with RMS eligible for 1st treatment with CladT (EU labelling). The primary outcome was overall treatment satisfaction at 6 months (Treatment Satisfaction Questionnaire for Medication [TSQM]-14, v. 1.4), Global Satisfaction subscale. Secondary endpoints were TSQM-14 scores for convenience, satisfaction with side effects and satisfaction with effectiveness. Patients provided written informed consent. RESULTS Of 63 patients screened, 58 received CladT and 55 completed the study. Mean age was 33 ± 9 years; mean weight 73 ± 17 kg; 31% male/69% female; mostly from the United Arab Emirates (52%) or Kuwait (30%). All had RMS (mean 0.9 ± 1.1 relapses in the past year), mean Expanded Disability Status Scale (EDSS) 1.4 ± 1.2; 36% were DMT-naïve. Mean [95% CI] score was high for overall treatment satisfaction (77.8 [73.0-82.6]), ease of use (87.4 [83.7-91.0]), tolerability (94.2 [91.0-97.3]) and effectiveness (76.2 [71.6-80.7]). Scores were similar irrespective of DMT history, age, gender, relapse history or EDSS. No relapses or serious treatment-emergent adverse events (TEAE) occurred. Two severe TEAE occurred (fatigue, headache) and 16% reported lymphopenia (two cases of grade 3 lymphopenia). Absolute lymphocyte counts at baseline and 6 months were 2.2 ± 0.8 × 109/L and 1.3 ± 0.3 × 109/L, respectively. CONCLUSIONS Treatment satisfaction, ease of use, tolerability and patient-perceived effectiveness for CladT were high, irrespective of baseline demographics, disease characteristics and prior treatment.
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Affiliation(s)
- Jihad Inshasi
- Rashid Hospital and Dubai Medical College and Dubai Health Authority (DHA), P.O. Box 4545, Dubai, UAE.
| | - Samar Farouk
- Ibn Sina Hospital, Kuwait, Kuwait
- Faculty of Medicine, Minia University, Minia, Egypt
| | | | - Ali Hassan
- Tawam Hospital, Abu Dhabi, UAE
- College of Medicine and Health Science, United Arab Emirates University, Abu Dhabi, UAE
| | - Miklos Szolics
- Tawam Hospital, Abu Dhabi, UAE
- College of Medicine and Health Science, United Arab Emirates University, Abu Dhabi, UAE
| | | | | | | | - Abubaker Almadani
- Rashid Hospital and Dubai Medical College and Dubai Health Authority (DHA), P.O. Box 4545, Dubai, UAE
| | | | | | | | - Anu Jacob
- Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
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Trinka E, Alsaadi T, Goji H, Maehara T, Takahashi S, Jacobs J, Renna R, Gil-López FJ, McMurray R, Sáinz-Fuertes R, Villanueva V. Perampanel for the treatment of people with idiopathic generalized epilepsy in clinical practice. Epilepsia 2023; 64:2094-2107. [PMID: 37114853 DOI: 10.1111/epi.17631] [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: 01/24/2023] [Revised: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE This study was undertaken to evaluate perampanel (PER) when used under real-world conditions to treat people with idiopathic generalized epilepsy (IGE) included in the PERaMpanel pooled analysIs of effecTiveness and tolerability (PERMIT) study. METHODS The multinational, retrospective, pooled analysis PERMIT explored the use of PER in people with focal and generalized epilepsy treated in clinical practice across 17 countries. This subgroup analysis included PERMIT participants with IGE. Time points for retention and effectiveness measurements were 3, 6, and 12 months (last observation carried forward, defined as "last visit," was also applied to effectiveness). Effectiveness was evaluated by seizure type (total seizures, generalized tonic-clonic seizures [GTCS], myoclonic seizures, absence seizures) and included ≥50% responder rate and seizure freedom rate (defined as no seizures since at least the previous visit). Safety/tolerability was monitored throughout PER treatment and evaluated by documenting the incidence of adverse events (AEs), including psychiatric AEs and those leading to treatment discontinuation. RESULTS The Full Analysis Set included 544 people with IGE (51.9% women, mean age = 33.3 years, mean epilepsy duration = 18.1 years). At 3, 6, and 12 months, 92.4%, 85.5%, and 77.3% of participants were retained on PER treatment, respectively (Retention Population, n = 497). At the last visit, responder and seizure freedom rates were, respectively, 74.2% and 54.6% (total seizures), 81.2% and 61.5% (GTCS), 85.7% and 66.0% (myoclonic seizures), and 90.5% and 81.0% (absence seizures) (Effectiveness Population, n = 467). AEs occurred in 42.9% of patients and included irritability (9.6%), dizziness/vertigo (9.2%), and somnolence (6.3%) (Tolerability Population, n = 520). Treatment discontinuation due to AEs was 12.4% over 12 months. SIGNIFICANCE This subgroup analysis of the PERMIT study demonstrated the effectiveness and good tolerability of PER in people with IGE when administered under everyday clinical practice conditions. These findings are in line with clinical trial evidence, supporting PER's use as broad-spectrum antiseizure medication for the treatment of IGE.
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Affiliation(s)
- Eugen Trinka
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience, Member of EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience, Salzburg, Austria
- Institute of Public Health, Medical Decision-Making, and HTA, UMIT-Private University for Health Sciences, Medical Informatics, and Technology, Hall in Tyrol, Austria
| | - Taoufik Alsaadi
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, United Arab Emirates
| | - Hiroko Goji
- Neuropsychiatric Department, Aichi Medical University, Nagakute, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Neurosurgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Satoru Takahashi
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Julia Jacobs
- Alberta Children's Hospital, Calgary, Alberta, Canada
- University Medical Center Freiburg, Member of EpiCARE, Freiburg, Germany
| | - Rosaria Renna
- Neurological Clinic and Stroke Unit, "A. Cardarelli" Hospital, Naples, Italy
| | | | | | | | - Vicente Villanueva
- Refractory Epilepsy Unit, Hospital Universitario y Politécnico La Fe, member of EpiCARE, Valencia, Spain
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Alsaadi T, Almadani A, Al-Hashel J, Al Salti A, Melikyan G, Khan RA. Commentary: Consensus Guidelines on the Appropriate Use of Brand-Name and Generic Anti-Seizure Medication for the Management of Epilepsy in the Gulf Region. Neurol Ther 2023; 12:1015-1031. [PMID: 37222860 PMCID: PMC10310631 DOI: 10.1007/s40120-023-00491-8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/28/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION The clinical, social, and economic burden of epilepsy is undeniable. Local guidance on epilepsy management is limited and needed to address the both use of anti-seizure medication (ASM) and switching practices which influence clinical outcomes. AREAS COVERED An expert panel composed of practicing neurologists and epileptologists from countries of the Gulf Cooperation Council (GCC) met in 2022 to discuss local challenges in the management of epilepsy and formulate recommendations for clinical practice. Published literature on the outcomes of ASM switching was reviewed along with clinical practice/gaps, international guidelines, and local treatment availabilities. EXPERT OPINION Improper ASM use and inappropriate brand-name-to-generic or generic-to-generic switching can contribute to worsening clinical outcomes in epilepsy. ASMs should be used for the management of epilepsy based on patient clinical profile, underlying epilepsy syndrome, and drug availability to ensure optimal and sustainable treatment. Both first-generation and newer ASMs can be considered; appropriate use is recommended from the beginning of treatment. It is critical to avoid inappropriate ASM switching to avoid breakthrough seizures. All generic ASMs should fulfill strict regulatory requirements. If needed, ASM changes should always be approved by the treating physician. ASM switching (brand-name-to-generic, generic-to-generic, generic-to-brand-name) should be avoided in epilepsy patients who have achieved control but can be considered for those uncontrolled on current medication.
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Affiliation(s)
- Taoufik Alsaadi
- Neurology Department, American Center for Psychiatry and Neurology, Abu Dhabi, UAE.
| | | | - Jasem Al-Hashel
- Department of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | - Gayane Melikyan
- Neurology, Weill Cornell Medical College-Qatar (WCMC-Q), Ar-Rayyan, Qatar
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Asadi-Pooya AA, Brigo F, Trinka E, Lattanzi S, Adel Kishk N, Karakis I, Ristic AJ, Alsaadi T, Alkhaldi M, Turuspekova ST, Aljandeel G, Al-Asmi A, Contreras G, Daza-Restrepo A, Kutlubaev MA, Guekht A, Calle-López Y, Jusupova A, San-Juan D, Khachatryan SG, Gigineishvili D, Mesraoua B, Dubenko A, Mirzaei Damabi N. A global survey on the attitudes of neurologists and psychiatrists about functional/psychogenic/dissociative/nonepileptic-seizures/attacks, in the search of its name. Epilepsy Behav 2023; 145:109292. [PMID: 37321160 DOI: 10.1016/j.yebeh.2023.109292] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE We conducted an observational study to investigate the opinions of neurologists and psychiatrists all around the world who are taking care of patients with seizures [epilepsy and functional seizures (FS)]. METHODS Practicing neurologists and psychiatrists from around the world were invited to participate in an online survey. On 29th September 2022, an e-mail including a questionnaire was sent to the members of the International Research in Epilepsy (IR-Epil) Consortium. The study was closed on 1st March 2023. The survey, conducted in English, included questions about physicians' opinions about FS and anonymously collected data. RESULTS In total, 1003 physicians from different regions of the world participated in the study. Both neurologists and psychiatrists identified "seizures" as their preferred term. Overall, the most preferred modifiers for "seizures" were "psychogenic" followed by "functional" by both groups. Most participants (57.9%) considered FS more difficult to treat compared to epilepsy. Both psychological and biological problems were considered as the underlying cause of FS by 61% of the respondents. Psychotherapy was considered the first treatment option for patients with FS (79.9%). CONCLUSION Our study represents the first large-scale attempt of investigating physicianś attitudes and opinions about a condition that is both frequent and clinically important. It shows that there is a broad spectrum of terms used by physicians to refer to FS. It also suggests that the biopsychosocial model has gained its status as a widely used framework to interpret and inform clinical practice on the management of patients.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria.
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, 5020 Salzburg, Austria; Institute Neuroscience Christian-Doppler Medical Centre, Paracelsus Medical University, Austria; Centre for Cognitive Neuroscience, 5020 Salzburg, Austria; Member of the European Referencenetwork EpiCARE, European; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology,Hall in Tirol, Austria.
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
| | - Nirmeen Adel Kishk
- Department of Neurology, Cairo University Epilepsy Unit (CUEU), School of Medicine, Cairo University, Cairo, Egypt.
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Aleksandar J Ristic
- Clinic for Neurology, Clinical Center of Serbia, Medical Faculty University of Belgrade, Serbia.
| | - Taoufik Alsaadi
- Deptartment of Neurology, American Center for Psychiatry and Neurology, and Khalifa University, Abu Dhabi, UAE.
| | - Modhi Alkhaldi
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O Box 34212, Dammam, Saudi Arabia.
| | - Saule T Turuspekova
- Department of Nervous Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan.
| | - Ghaieb Aljandeel
- Iraqi Council for Medical Specializations, Faculty of Epileptology, Medical City, Baghdad, Iraq.
| | - Abdullah Al-Asmi
- Neurology Unit, Department of Medicine, College of Medicine and Health Sciences and Sultan Qaboos University Hospital, Sultan Qaboos University, Oman.
| | | | - Anilu Daza-Restrepo
- Neurosciences and Complex Systems Unit (ENyS), Epilepsy Unit, CONICET, Hosp. El Cruce "N. Kirchner", Univ. Nat. A. Jauretche (UNAJ), F. Varela, Prov. Buenos Aires, Argentina.
| | - Mansur A Kutlubaev
- Department of Neurology, Bashkir State Medical University, Ufa., Russia.
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Department of Neurology, Nerosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russia.
| | - Yamile Calle-López
- Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia; Hospital Universitario San Vicente Fundación, Medellín, Colombia.
| | - Asel Jusupova
- Kyrgyz State Medical Academy, Neurology and Clinical Genetics Department, Bishkek, Kyrgyzstan.
| | - Daniel San-Juan
- Epilepsy Clínic. National Institute of Neurology and Neurosurgery, México City, Mexico.
| | - Samson G Khachatryan
- Department of Neurology and Neurosurgery, National Institute of Health, Yerevan, Armenia.
| | - David Gigineishvili
- Institute of Neurology, Javakhishvili Tbilisi State University, Department of Neurology & Neurosurgery, Tbilisi, Georgia.
| | - Boulenouar Mesraoua
- Neurosciences Department, Hamad Medical Corporation and Weill Cornell Medical College, Doha, Qatar.
| | - Andriy Dubenko
- Institute of Neurology, Psychiatry and Narcology of NAMS, Ukraine.
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10
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Asadi-Pooya AA, Brigo F, Trinka E, Lattanzi S, Karakis I, Kishk NA, Valente KD, Jusupova A, Turuspekova ST, Daza-Restrepo A, Contreras G, Kutlubaev MA, Guekht A, Rahimi-Jaberi A, Aljandeel G, Calle-Lopez Y, Alsaadi T, Ashkanani A, Ranganathan LN, Al-Asmi A, Khachatryan SG, Gigineishvili D, Mesraoua B, Mwendaweli N. Physicians’ beliefs about brain surgery for drug-resistant epilepsy: A global survey. Seizure 2022; 103:18-22. [DOI: 10.1016/j.seizure.2022.10.012] [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] [Received: 08/12/2022] [Revised: 09/20/2022] [Accepted: 10/09/2022] [Indexed: 11/19/2022] Open
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11
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Alsaadi T, Toledo M, Loro FA, Trinka E, Wu T, Malhotra M, Ngo LY, Gil-Nagel A, Villanueva V. 070 Real-world experience of perampanel monotherapy in epilepsy patients with focal-onset and generalised-onset seizures. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.114] [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: 11/03/2022]
Abstract
Data from 44 pooled clinical practice studies were compared for epilepsy patients with focal-onset and/or generalised-onset seizures treated with perampanel (PER) monotherapy (n=268) (first-line or conversion to monotherapy). Retention was assessed after 3, 6 and 12 months of PER treatment. Seizure freedom rates and responder rates (≥50% seizure frequency reduction), assessed by seizure type at last visit were evaluated (last observation carried forward). Adverse events (AEs) and discontinuation due to AEs were evaluated. Seizure types at baseline were focal-onset only (75.0%), generalised-onset only (24.5%), and focal-onset and generalised-onset (0.5%). At 3, 6 and 12 months, retention rates were 91.1%, 87.3% and 73.3%, respectively. At last visit, seizure freedom rates in patients with focal-onset and generalised-onset seizures were 64.1% and 69.4%, respectively; corresponding responder rates were 84.4% and 93.9%, respec- tively. AEs were reported for 45.2% of patients, with the most frequent (≥10% of patients) being dizziness/vertigo (16.8%) and irritability (11.2%); 13.7% of patients discontinued due to AEs over 12 months. Psychiatric AEs were reported for 20.8% of patients. In conclusion, PER was effective and generally well-tolerated as monotherapy for focal-onset and/or generalised-onset seizures in everyday clinical practice. At last visit, approximately two-thirds of patients were seizure free.Supported by Eisai
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12
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Alsaadi T, Noori S, Varakian R, Youssef S, Almadani A. Real-world experience of erenumab in patients with chronic or episodic migraine in the UAE. BMC Neurol 2022; 22:221. [PMID: 35710354 PMCID: PMC9202108 DOI: 10.1186/s12883-022-02710-5] [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: 01/28/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Erenumab is a fully human monoclonal antibody and a highly potent, first-in-class calcitonin gene-related peptide receptor inhibitor approved for migraine prevention in adults. Randomised, placebo-controlled trials show that erenumab treatment results in clinically meaningful responses, including significant reductions in monthly migraine days. Real-world evidence of the effectiveness of erenumab in patients with migraine is accruing, but gaps remain, and findings may vary according to region. We evaluated the usage patterns and effectiveness of erenumab in real-world settings in patients with migraine in the United Arab Emirates (UAE). Methods This retrospective, observational real-world study enrolled patients ≥ 18 years with migraine who were prescribed erenumab in the UAE. Data were collected at baseline and Months 1, 3 and 6. The primary study objective was to characterise usage patterns of erenumab in patients with chronic migraine (CM) or episodic migraine (EM) in real-world settings in the UAE. Results Of the 166 patients, 124 (74.7%) were females. The mean (standard deviation) age at migraine onset was 29 (7.93) years. Seventy-one patients (42.8%) had CM and 95 (57.2%) had EM. In the overall population, the mean monthly headache/migraine days (MHD) at baseline was 15.7 (8.45) and mean change from baseline was − 8.2 (8.83) at Month 1, − 11.0 (9.15) at Month 3 and − 11.3 (8.90) at Month 6. The mean change from baseline in monthly acute migraine-specific medication days (MSMD) was − 9.0 (8.07) at Month 1, − 9.7 (8.73) at Month 3 and − 10.7 (8.95) at Month 6. At all time points, most patients achieved at least 50% reduction in MHD (80%–91%) and MSMD (84%–94%). Similar reductions in MHD and MSMD and clinical benefit in CM or EM were seen with erenumab monotherapy or erenumab add-on therapy, with or without dose escalation and for treatment naïve or ≥ 1 previous preventive treatment failures, with additional clinical benefit in the erenumab add-on therapy and dose escalation to 140 mg subgroups. Conclusion In this real-world study on erenumab use in the UAE, patients prescribed erenumab achieved clinically meaningful reductions in MHD and MSMD at all assessed time points. Erenumab was well tolerated with no new safety events. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02710-5.
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Affiliation(s)
- Taoufik Alsaadi
- Department of Neurology, American Center of Psychiatry and Neurology, Abu Dhabi, United Arab Emirates.
| | - Suzan Noori
- University of Sharjah, Sharjah, United Arab Emirates
| | - Razmig Varakian
- Representative office, Novartis Middle East FZE, Dubai, United Arab Emirates
| | - Saly Youssef
- Representative office, Novartis Middle East FZE, Dubai, United Arab Emirates
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13
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Hirsch E, French J, Scheffer IE, Bogacz A, Alsaadi T, Sperling MR, Abdulla F, Zuberi SM, Trinka E, Specchio N, Somerville E, Samia P, Riney K, Nabbout R, Jain S, Wilmshurst JM, Auvin S, Wiebe S, Perucca E, Moshé SL, Tinuper P, Wirrell EC. ILAE definition of the Idiopathic Generalized Epilepsy Syndromes: Position statement by the ILAE Task Force on Nosology and Definitions. Epilepsia 2022; 63:1475-1499. [PMID: 35503716 DOI: 10.1111/epi.17236] [Citation(s) in RCA: 121] [Impact Index Per Article: 60.5] [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: 04/23/2021] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 12/13/2022]
Abstract
In 2017, the International League Against Epilepsy (ILAE) Classification of Epilepsies described the "genetic generalized epilepsies" (GGEs), which contained the "idiopathic generalized epilepsies" (IGEs). The goal of this paper is to delineate the four syndromes comprising the IGEs, namely childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy, and epilepsy with generalized tonic-clonic seizures alone. We provide updated diagnostic criteria for these IGE syndromes determined by the expert consensus opinion of the ILAE's Task Force on Nosology and Definitions (2017-2021) and international external experts outside our Task Force. We incorporate current knowledge from recent advances in genetic, imaging, and electroencephalographic studies, together with current terminology and classification of seizures and epilepsies. Patients that do not fulfill criteria for one of these syndromes, but that have one, or a combination, of the following generalized seizure types: absence, myoclonic, tonic-clonic and myoclonic-tonic-clonic seizures, with 2.5-5.5 Hz generalized spike-wave should be classified as having GGE. Recognizing these four IGE syndromes as a special grouping among the GGEs is helpful, as they carry prognostic and therapeutic implications.
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Affiliation(s)
- Edouard Hirsch
- Francis Rohmer Neurology Epilepsy Units, National Institute of Health and Medical Research 1258, Federation of Translational Medicine of Strasbourg, Strasbourg University, Strasbourg, France
| | - Jacqueline French
- New York University Grossman School of Medicine and NYU Langone Health, New York, New York, USA
| | - Ingrid E Scheffer
- Austin Health and Royal Children's Hospital, Florey Institute, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Alicia Bogacz
- Institute of Neurology, Clinical Hospital, Faculty of Medicine, University of the Republic, Montevideo, Uruguay
| | - Taoufik Alsaadi
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, United Arab Emirates
| | - Michael R Sperling
- Department of Neurology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Fatema Abdulla
- Salmaniya Medical Complex-Government Hospital, Manama, Bahrain
| | - Sameer M Zuberi
- Paediatric Neurosciences Research Group, Royal Hospital for Children and Institute of Health & Wellbeing, University of Glasgow, member of EpiCARE, Glasgow, UK
| | - Eugen Trinka
- Department of Neurology and Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience, member of EpiCARE, Salzburg, Austria.,Department of Public Health, Health Services Research, and Health Technology Assessment, University for Health Sciences, Medical Informatics, and Technology, Hall in Tirol, Austria
| | - Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Scientific Institute for Research and Health Care, member of EpiCARE, Rome, Italy
| | - Ernest Somerville
- Prince of Wales Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Pauline Samia
- Department of Pediatrics and Child Health, Aga Khan University, East Africa, Nairobi, Kenya
| | - Kate Riney
- Neurosciences Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Rima Nabbout
- Reference Center for Rare Epilepsies, Department of Pediatric Neurology, Necker-Enfants Malades Hospital, Public Hospital Network of Paris, member of EpiCARE, Imagine Institute, National Institute of Health and Medical Research, Mixed Unit of Research 1163, University of Paris, Paris, France
| | | | - Jo M Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Stephane Auvin
- Pediatric Neurology, Public Hospital Network of Paris, Robert Debré Hospital, NeuroDiderot, National Institute of Health and Medical Research, Department Medico-Universitaire, Innovation Robert-Debré, University of Paris, Paris, France.,University Institute of France, Paris, France
| | - Samuel Wiebe
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Emilio Perucca
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Solomon L Moshé
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology, and Departments of Neuroscience and Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Institute of Neurological Sciences, Scientific Institute for Research and Health Care, member of EpiCARE, Bologna, Italy
| | - Elaine C Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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14
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Wirrell EC, Nabbout R, Scheffer IE, Alsaadi T, Bogacz A, French JA, Hirsch E, Jain S, Kaneko S, Riney K, Samia P, Snead OC, Somerville E, Specchio N, Trinka E, Zuberi SM, Balestrini S, Wiebe S, Cross JH, Perucca E, Moshé SL, Tinuper P. Methodology for classification and definition of epilepsy syndromes with list of syndromes: Report of the ILAE Task Force on Nosology and Definitions. Epilepsia 2022; 63:1333-1348. [PMID: 35503715 DOI: 10.1111/epi.17237] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [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: 04/23/2021] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 01/01/2023]
Abstract
Epilepsy syndromes have been recognized for >50 years, as distinct electroclinical phenotypes with therapeutic and prognostic implications. Nonetheless, no formally accepted International League Against Epilepsy (ILAE) classification of epilepsy syndromes has existed. The ILAE Task Force on Nosology and Definitions was established to reach consensus regarding which entities fulfilled criteria for an epilepsy syndrome and to provide definitions for each syndrome. We defined an epilepsy syndrome as "a characteristic cluster of clinical and electroencephalographic features, often supported by specific etiological findings (structural, genetic, metabolic, immune, and infectious)." The diagnosis of a syndrome in an individual with epilepsy frequently carries prognostic and treatment implications. Syndromes often have age-dependent presentations and a range of specific comorbidities. This paper describes the guiding principles and process for syndrome identification in both children and adults, and the template of clinical data included for each syndrome. We divided syndromes into typical age at onset, and further characterized them based on seizure and epilepsy types and association with developmental and/or epileptic encephalopathy or progressive neurological deterioration. Definitions for each specific syndrome are contained within the corresponding position papers.
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Affiliation(s)
- Elaine C Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rima Nabbout
- Reference Center for Rare Epilepsies, Department of Pediatric Neurology, Necker-Sick Children Hospital, Public Hospital Network of Paris, member of EpiCARE, Paris, France.,Imagine Institute, National Institute of Health and Medical Research, Mixed Unit of Research 1163, University of Paris, Paris, France
| | - Ingrid E Scheffer
- Austin Health and Royal Children's Hospital, Florey Institute, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Taoufik Alsaadi
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, United Arab Emirates
| | - Alicia Bogacz
- Faculty of Medicine, Clinics Hospital, Institute of Neurology, University of the Republic, Montevideo, Uruguay
| | - Jacqueline A French
- New York University Grossman School of Medicine and NYU Langone Health, New York, New York, USA
| | - Edouard Hirsch
- Francis Rohmer Neurology Epilepsy Unit, National Institute of Health and Medical Research 1258, Federation of Translational Medicine of Strasbourg, Strasbourg University, Strasbourg, France
| | | | - Sunao Kaneko
- North Tohoku Epilepsy Center, Minato Hospital, Hachinohe, Japan
| | - Kate Riney
- Neurosciences Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Pauline Samia
- Department of Pediatrics and Child Health, Aga Khan University, Nairobi, Kenya
| | - O Carter Snead
- Department Pediatrics [Neurology], Faculty of Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ernest Somerville
- Prince of Wales Hospital and University of New South Wales, Sydney, New South Wales, Australia
| | - Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Scientific Institute for Research and Health Care, member of EpiCARE, Rome, Italy
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria.,Center for Cognitive Neuroscience, member of EpiCARE, Salzburg, Austria.,Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Sameer M Zuberi
- Paediatric Neurosciences Research Group, Royal Hospital for Children and Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.,Collaborating Centre of European Reference Network EpiCARE, Glasgow, UK
| | - Simona Balestrini
- Neuroscience Department, Meyer Children's Hospital-University of Florence, Florence, Italy.,Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Buckinghamshire, UK
| | - Samuel Wiebe
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - J Helen Cross
- Programme of Developmental Neurosciences, University College London National Institute for Health Research Biomedical Research Centre Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.,Young Epilepsy Lingfield, Lingfield, UK
| | - Emilio Perucca
- Department of Neurosciences, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Solomon L Moshé
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology, and Departments of Neuroscience and Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Institute of Neurological Sciences, Scientific Institute for Research and Health Care, Bologna, Italy
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15
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Riney K, Bogacz A, Somerville E, Hirsch E, Nabbout R, Scheffer IE, Zuberi SM, Alsaadi T, Jain S, French J, Specchio N, Trinka E, Wiebe S, Auvin S, Cabral-Lim L, Naidoo A, Perucca E, Moshé SL, Wirrell EC, Tinuper P. International League Against Epilepsy classification and definition of epilepsy syndromes with onset at a variable age: position statement by the ILAE Task Force on Nosology and Definitions. Epilepsia 2022; 63:1443-1474. [PMID: 35503725 DOI: 10.1111/epi.17240] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [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: 04/23/2021] [Revised: 03/12/2022] [Accepted: 03/16/2022] [Indexed: 01/15/2023]
Abstract
The goal of this paper is to provide updated diagnostic criteria for the epilepsy syndromes that have a variable age of onset, based on expert consensus of the International League Against Epilepsy Nosology and Definitions Taskforce (2017-2021). We use language consistent with current accepted epilepsy and seizure classifications and incorporate knowledge from advances in genetics, electroencephalography, and imaging. Our aim in delineating the epilepsy syndromes that present at a variable age is to aid diagnosis and to guide investigations for etiology and treatments for these patients.
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Affiliation(s)
- Kate Riney
- Neurosciences Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, South Brisbane, Queensland, Australia
| | - Alicia Bogacz
- Institute of Neurology, University of the Republic, Montevideo, Uruguay
| | - Ernest Somerville
- Prince of Wales Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Edouard Hirsch
- Francis Rohmer Epilepsy Unit, Hautepierre Hospital, Strasbourg, France.,National Institute of Health and Medical Research 1258, Strasbourg, France.,Federation of Translational Medicine of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Rima Nabbout
- Reference Centre for Rare Epilepsies, Assistance Publique - Hôpitaux de Paris, Department of Pediatric Neurology, Necker-Enfants Malades Hospital, Member of Epicare, Paris, France.,Imagine Institute, National Institute of Health and Medical Research Mixed Unit of Research 1163, Paris, France.,University City University, Paris, France
| | - Ingrid E Scheffer
- Austin Health, Royal Children's Hospital, Florey Institute and Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Sameer M Zuberi
- University City University, Paris, France.,Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK.,Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Taoufik Alsaadi
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, United Arab Emirates
| | | | - Jacqueline French
- New York University Grossman School of Medicine and NYU Langone Health, New York, New York, USA
| | - Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Scientific Institute for Research and Health Care, member of EpiCARE, Rome, Italy
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience, member of EpiCARE, Salzburg, Austria.,Neuroscience Institute, Christian Doppler University Hospital, Center for Cognitive Neuroscience, Salzburg, Austria.,Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics, and Technology, Hall in Tirol, Austria
| | - Samuel Wiebe
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Stéphane Auvin
- Institut Universitaire de France, Paris, France.,Paediatric Neurology, Assistance Publique - Hôpitaux de Paris, Robert-Debré Hospital, Paris, France.,University of Paris, Paris, France
| | - Leonor Cabral-Lim
- Department of Neurosciences, College of Medicine and Philippine General Hospital, Health Sciences Center, University of the Philippines Manila, Manila, the Philippines
| | - Ansuya Naidoo
- Neurology Unit, Greys Hospital, Pietermaritzburg, South Africa.,Department of Neurology, University of KwaZulu Natal, KwaZulu Natal, South Africa
| | - Emilio Perucca
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia.,Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Solomon L Moshé
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology and Departments of Neuroscience and Pediatrics, Albert Einstein College of Medicine, New York, New York, USA.,Montefiore Medical Center, Bronx, New York, USA
| | - Elaine C Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Reference Centre for Rare and Complex Epilepsies, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
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16
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Saleh DA, Kassie S, Hassan A, Alsaadi T. Sudden unexpected death in epilepsy: A pilot study on neurologists' knowledge and experience in the Eastern Mediterranean region. Seizure 2021; 94:57-65. [PMID: 34864253 DOI: 10.1016/j.seizure.2021.11.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/25/2021] [Accepted: 11/18/2021] [Indexed: 01/08/2023] Open
Abstract
Background- Sudden unexpected death in epilepsy (SUDEP) is an important concern in patients with epilepsy who are otherwise healthy. Current knowledge of SUDEP and attitudes of neurologists in the Eastern Mediterranean Region (EMR) towards discussing SUDEP with their patients remain unknown. Objective- We aimed at assessing knowledge, attitudes and factors affecting SUDEP discussion practices of neurologists practicing in the EMR. Methodology- An electronic and paper-based survey was sent to 350 neurologists practicing in the EMR. They were questioned about the frequency, timing, and factors affecting their willingness to initiate SUDEP discussion. We also included questions about perceived patient reactions towards SUDEP discussions and neurologists' preferred way to provide SUDEP information to their patients. Results- We received 132 responses from the 350 surveys sent out (response rate 37.7%). Our results showed that only 1.5% of the neurologists discussed SUDEP with "most" of their patients and their caregivers while 55.3% "rarely" or "never" discussed it. Factors such as additional epilepsy training and more years of clinical experience did not significantly affect the frequency of SUDEP discussion (p = 0.329, p = 0.728). A significant negative association between the number of patients seen per year and the frequency of SUDEP discussion was seen (P= 0.046). Based on their selection of known risk factors, 81% of neurologists were considered as having insufficient knowledge of SUDEP. The top three perceived reactions by the neurologists on SUDEP discussion were distress (74.2%), anxiety (70.5%) and depression (65.9%). Most neurologists initiated SUDEP discussion by themselves and preferred brochures/pamphlets, websites and training sessions to provide SUDEP information. Conclusion- Neurologists in the EMR rarely discuss SUDEP, and have limited knowledge about its risk factors. Upon discussing SUDEP, they overwhelmingly receive negative reactions but not always. Based on our findings, we believe an unintended knowledge gap exists on part of the neurologists. This, coupled with a lack of trained epilepsy nurses and patient education material in regional languages can also be attributed to poor SUDEP discussion practices in the EMR.
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Affiliation(s)
- Dina Amin Saleh
- Division of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE; Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Seada Kassie
- Division of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE
| | - Abeera Hassan
- Division of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE.
| | - Taoufik Alsaadi
- Division of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE
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Inshasi JS, Alfahad S, Alsaadi T, Hassan A, Zein T, Mifsud VA, Nouri SI, Shakra M, Shatila AO, Szolics M, Thakre M, Kumar A, Boshra A. Position of Cladribine Tablets in the Management of Relapsing-Remitting Multiple Sclerosis: An Expert Narrative Review From the United Arab Emirates. Neurol Ther 2021; 10:435-454. [PMID: 33891277 PMCID: PMC8062252 DOI: 10.1007/s40120-021-00243-6] [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: 02/05/2021] [Accepted: 03/16/2021] [Indexed: 11/06/2022] Open
Abstract
The use of immune reconstitution therapies (IRT) in patients with relapsing-remitting multiple sclerosis (RRMS) is associated with a prolonged period of freedom from relapses in the absence of continuously applied therapy. Cladribine tablets is a disease-modifying treatment (DMT) indicated for highly active relapsing multiple sclerosis (MS) as defined by clinical or imaging features. Treatment with cladribine tablets is effective and well tolerated in patients with active MS disease and have a low burden of monitoring during and following treatment. In this article, an expert group of specialist neurologists involved in the care of patients with MS in the United Arab Emirates provides their consensus recommendations for the practical use of cladribine tablets according to the presenting phenotype of patients with RRMS. The IRT approach may be especially useful for patients with highly active MS insufficiently responsive to treatment with a first-line DMT, those who are likely to adhere poorly to a continuous therapeutic regimen, treatment-naïve patients with high disease activity at first presentation, or patients planning a family who are prepared to wait until at least 6 months after the end of treatment. Information available to date does not suggest an adverse interaction between cladribine tablets and COVID-19 infection. Data are unavailable at this time regarding the efficacy of COVID-19 vaccination in patients treated with cladribine tablets. Robust immunological responses to COVID-19 infection or to other vaccines have been observed in patients receiving this treatment, and treatment with cladribine tablets per se should not represent a barrier to this vaccination.
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Affiliation(s)
- Jihad S Inshasi
- Neurology Department, Rashid Hospital and Dubai Medical College, Dubai Health Authority (DHA), PO Box 4545, Dubai, UAE.
| | - Sarmed Alfahad
- Neurology Department, Neurospinal Hospital, Baghdad Medical College, Dubai, UAE
| | - Taoufik Alsaadi
- Neurology Department, American Center for Psychiatry and Neurology, Dubai, UAE
| | - Ali Hassan
- Neurology Medical Clinic, Tawam Hospital, Abu Dhabi, UAE
| | - Tayseer Zein
- Neurology Department, AlQassami Hospital, Sharjah, UAE
| | | | | | - Mustafa Shakra
- Department of Neurology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | | | - Miklos Szolics
- Neurology Medical Clinic, Tawam Hospital, Abu Dhabi, UAE
| | - Mona Thakre
- Neurology Department, Al Zahra Hospital, Dubai, UAE
| | - Ajit Kumar
- Neurology Department, NMC Specialty Hospital, Al Nahda, Dubai, UAE
| | - Amir Boshra
- Merck Serono Middle East FZ Ltd, Dubai, UAE
- Merck KgaA, Darmstadt, Germany
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18
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Asadi-Pooya AA, Brigo F, Lattanzi S, Karakis I, Asadollahi M, Trinka E, Talaat El Ghoneimy L, Pretorius C, Contreras G, Daza-Restrepo A, Valente K, D'Alessio L, Turuspekova ST, Aljandeel G, Khachatryan S, Ashkanani A, Tomson T, Kutlubaev M, Guekht A, Alsaadi T, Calle-Lopez Y, Mesraoua B, Ríos-Pohl L, Al-Asmi A, Villanueva V, Igwe SC, Kissani N, Jusupova A. Complementary and alternative medicine in epilepsy: A global survey of physicians' opinions. Epilepsy Behav 2021; 117:107835. [PMID: 33611098 DOI: 10.1016/j.yebeh.2021.107835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/25/2020] [Accepted: 01/30/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the opinions of physicians on the use of complementary and alternative medicine (CAM) in patients with epilepsy (PWE) worldwide. METHODS Online survey addressed to neurologists and psychiatrists from different countries. RESULTS Totally, 1112 physicians from 25 countries (different world region: Europe, North America, South America, Middle-East, Africa, Former Soviet Union Republics) participated; 804 (72.3%) believed that CAM might be helpful in PWE. The most commonly endorsed CAM included meditation (41%) and yoga (39%). Female sex, psychiatry specialization, and working in North and South America were associated with the belief that CAM is helpful in PWE. Two-hundred and forty five out of 1098 participants (22.3%) used/prescribed CAM to PWE; among them, 174 (71%) people perceived CAM to be less effective and 114 (46.5%) people found CAM to be safer than conventional antiseizure medications (ASMs). The most common reasons to prescribe CAM for PWE were: to satisfy the patient (49.9%), dissatisfaction with the efficacy (35.6%), and dissatisfaction with the adverse effects (31.2%) of conventional therapies. CONCLUSION Although the evidence supporting the use of CAM for the treatment of epilepsy is extremely sparse, most physicians worldwide believe that it could be integrated with the use of conventional ASMs, at least in some patients. High-quality controlled trials are warranted to provide robust evidence on the usefulness of CAM options in PWE.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Eugen Trinka
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, 5020 Salzburg, Austria; Institute of Nursing Science and Practice, Paracelsus Medical University, 5020 Salzburg, Austria; Centre for Cognitive Neuroscience, 5020 Salzburg, Austria, Associated Member of the European Reference Network EpiCARE
| | | | - Chrisma Pretorius
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Guilca Contreras
- Department of Pediatric Neurology, Hospital Metropolitano, Quito, Ecuador
| | | | - Kette Valente
- Laboratory of Clinical Neurophysiology, Deparment of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Luciana D'Alessio
- Buenos Aires University, Epilepsy Center, Ramos Mejía and El Cruce Hospitals, IBCN-CONICET, Buenos Aires, Argentina
| | - Saule T Turuspekova
- Department of Nervous Diseases with a Course of Neurosurgery, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Ghaieb Aljandeel
- Iraqi Council for Medical Specializations, Faculty of Epileptology, Medical City, Baghdad, Iraq
| | - Samson Khachatryan
- Department of Neurology and Neurosurgery, National Institute of Health, Yerevan, Armenia
| | | | - Torbjörn Tomson
- Department of Clinical Nueroscience, Karolinska institutet, Stockholm, Sweden
| | - Mansur Kutlubaev
- Department of Neurology, Bashkir State Medical University, Ufa, Russia
| | - Alla Guekht
- Moscow Research and Clinical Center for Neurospychiatry; Department of Neurology, Nerosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Taoufik Alsaadi
- Deptartment of Neurology, American Center for Psychiatry and Neurology, Dubai, United Arab Emirates
| | - Yamile Calle-Lopez
- Neurology Section, University of Antioquia, Fundación Clínica del Norte-Neuroclínica, Medellín, Colombia
| | - Boulenouar Mesraoua
- Neurosciences Department, Hamad Medical Corporation and Weill Cornell Medical College, Doha, Qatar
| | | | - Abdullah Al-Asmi
- Neurology Unit, Department of Medicine, College of Medicine and Health Sceinces, Sultan Qaboos University, Oman
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Stanley C Igwe
- Department of NeuroPsychiatry, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Najib Kissani
- Laboratory of Clinical and Experimental Neuroscience, Faculty of Medicine, Cadi Ayyad University, Marrakech, Morocco; Department of Neurology, Teaching Hospital Mohammed VI, Marrakesh, Morocco
| | - Asel Jusupova
- Kyrgyz State Medical Academy, Neurology and Clinical Genetics Department, Bishkek, Kyrgyzstan
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Shahrour T, Siddiq M, Mohan S, El Hammasi K, Alsaadi T. Four-year survey of medically serious suicide attempters in Abu Dhabi. East Mediterr Health J 2021; 27:227-232. [PMID: 33788211 DOI: 10.26719/emhj.20.099] [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] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 02/18/2020] [Indexed: 11/09/2022]
Abstract
Background It is well established that attempting suicide significantly increases a person's risk of completing suicide. The risk is considered to be particularly high in the first year after the attempt. Epidemiological information on suicide is scarce in the Middle East and the countries of the GCC region and there is a need to establish a reference point to measure future changes. Aims We examined the epidemiology of suicide attempters requiring inpatient care in Abu Dhabi to identify associated factors that could aid local suicide prevention strategies. Methods This 4-year (2011-2014) study of suicide attempters in the city of Abu Dhabi included all attempters assessed by the consultation-liaison team and admitted to the 3 main governmental general hospitals. Results We identified 364 suicide attempts with an annual incidence of 6 per 100 000 population. The mean age was 28.7 years. Females comprised 59.6% of the attempters and were more likely to be below age 30 years. Around 40% of the psychiatric diagnoses among attempters were related to stress and 17.9% to depression. Overdosing was the chosen method in 50.6% of the attempters, with 32.7% overdosing on paracetamol and females being more likely to use this method. Just over 13% of the attempters had made one previous attempt and 2.2% had made more than one. Conclusion Females younger than 30 years were at higher risk of attempting suicide, with overdosing on paracetamol as the preferred method. Stress-related diagnoses were predominant in the attempters.
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Affiliation(s)
- Tarek Shahrour
- Department of Psychiatry, Shiekh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Muez Siddiq
- Department of Psychiatry, Shiekh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Sona Mohan
- Department of Psychiatry, Shiekh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Khadija El Hammasi
- Department of Psychiatry, Shiekh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Taoufik Alsaadi
- American Center for Neurology and Psychiatry, Abu Dhabi, United Arab Emirates
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20
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Alroughani R, AlKawi Z, Hassan A, Al Otaibi H, Mujtaba A, Al Atat R, Riachi N, Akkawi N, Koussa S, Inshasi J, Alsaadi T, Ahmed SF, Al-Aasmi A, Zakaria M, El Fadally H. Real-world retrospective study of effectiveness and safety of FINgOlimod in relapsing remitting multiple sclerosis in the Middle East and North Africa (FINOMENA). Clin Neurol Neurosurg 2021; 203:106576. [PMID: 33714799 DOI: 10.1016/j.clineuro.2021.106576] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Evidence on the effectiveness and safety of fingolimod in real-world clinical practice in the Middle East and North African (MENA) region is limited. This study aimed to evaluate the effectiveness and safety of fingolimod in patients with relapsing-remitting multiple sclerosis (RRMS) in real-world setting in the MENA region. PATIENTS AND METHODS RRMS patients who had been treated with fingolimod for at least 12 months were retrospectively identified from the databases of 34 centers across the MENA region. Study outcomes included the annualized relapse rate (ARR), relapse-free rate (RFR), time to first and second relapses, mean change in Expanded Disability Status Scale (EDSS), proportion of patients with Magnetic Resonance Imaging (MRI) activity and no evidence of disease activity (NEDA)-3, retention of patients on treatment, as well as all safety measures. RESULTS A total of 806 patients were included: 66.34 % female; mean age 32.97 ± 9.62 years; mean disease duration 4.92 ± 4.66 years; mean fingolimod use 37.2 ± 16.7 months. Most patients had received previous disease-modifying therapy (79.65 %). Compared to the year preceding fingolimod initiation, RFR improved (33.00%-86.35%; p < 0.001), ARR decreased (0.84 ± 0.73 to 0.16 ± 0.45; p = 0.005), EDSS decreased (2.69 ± 1.74-2.01 ± 1.66; p < 0.001), and the proportion of patients with Gadolinium-enhancing T1 lesions decreased (57.84 % to 12.93 %; p < 0.001), after 12 months of fingolimod treatment. NEDA-3 was achieved in 41.3 % of patients. Median time to first and second relapses was not reached since 86.35 % and 98.39 % of patients had not experienced relapses for the first time and second time, respectively. Eight-hundred one (99.38 %) patients continued fingolimod treatment beyond 12 months. One-hundred thirty patients (16.13 %) experienced adverse events, mainly lymphopenia (5.46 %) and leukopenia (2.11 %), while 13 patients (1.61 %) experienced serious adverse events. CONCLUSION This study confirms the effectiveness and safety profile of fingolimod in real-world setting in the Middle East and North African (MENA) region.
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Affiliation(s)
| | | | - Ahmed Hassan
- King Faisal Specialist Hospital and Research Center, Saudi Arabia.
| | | | | | | | - Naji Riachi
- LAU Medical Center - Rizk Hospital, Lebanon.
| | - Nabil Akkawi
- Hammoud Hospital - University Medical Center, Lebanon.
| | | | | | - Taoufik Alsaadi
- American Center for Psychiatry and Neurology (ACPN), United Arab Emirates.
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21
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Asadi-Pooya AA, Brigo F, Lattanzi S, D'Alessio L, Daza-Restrepo A, Calle-Lopez Y, Hingray C, Alsaadi T, Mesraoua B, Gigineishvili D, Kutlubaev MA, Yaghmoor BE, Aljandeel GB, Sarudiasnky M, Scévola L, Contreras G, Lozada ME. Working restrictions and disability benefits eligibility in patients with functional (psychogenic) seizures: An international survey of physicians' opinions. Epilepsy Behav 2021; 115:107678. [PMID: 33348196 DOI: 10.1016/j.yebeh.2020.107678] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES In this international study, we aimed to investigate the opinions of physicians dealing with patients with functional seizures (FS) worldwide on working restrictions and disability benefits eligibility. METHODS International online survey of neurologists/mental health professionals from Argentina, Venezuela, Colombia, Italy, France, Iran, Iraq, United Arab Emirates (UAE), Qatar, Saudi Arabia, Georgia, and Russia. RESULTS Six hundred and twenty-seven physicians from 12 countries participated in the study. Working as a neurologist was a predictor to think that patients with FS should not be counseled to avoid performing all jobs or professions as long as they have active disease (OR: 0.46; 95% CI: 0.30 to 0.68; p < 0.001). Having managed more than 200 patients was associated with the opinion that patients should not be counseled to avoid performing any type of work (OR: 2.17; 95% CI: 1.02 to 4.59; p = 0.043). Working as a psychiatrist/psychologist was associated with the idea that patients with FS should be qualified for disability benefits (OR: 1.97; 95% CI: 1.21-3.21; p = 0.006), and receive these benefits lifelong (OR: 0.43; 95% CI: 0.22-0.84; p = 0.014). CONCLUSION Neurologists and mental health professionals have different attitudes and opinions toward working restrictions and disability benefits for patients with FS. Further studies should investigate the reasons for these differences, and propose solutions to avoid discrimination and unequal access to employment and disability benefits.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Luciana D'Alessio
- Buenos Aires University, IBCN-CONICET and Epilepsy Center, Ramos Mejía and El Cruce Hospitals, ENyS-CONICET, Buenos Aires, Argentina
| | | | - Yamile Calle-Lopez
- Neurology Section, Fundación Clínica del Norte- Neuroclínica - University of Antioquia, Medellín, Colombia
| | - Coraline Hingray
- Pole universitaire du grand Nancy, Centre Psychothérapeutique de Nancy, Service de Neurologie, CHRU Nancy, Nancy, France.
| | - Taoufik Alsaadi
- Department of Neurology-American Center for Psychiatry and Neurology, United Arab Emirates
| | | | - David Gigineishvili
- Javakhishvili Tbilisi State University, Department of Neurology & Neurosurgery, Tbilisi, Georgia.
| | | | - Bassam E Yaghmoor
- Division of Neurology, Department of Internal Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Ghaieb Bashar Aljandeel
- Iraqi Council for Medical Specializations, Faculty of Epileptology, Medical City, Baghdad, Iraq
| | - Mercedes Sarudiasnky
- CAEA, CONICET, University of Buenos Aires, School of Psychology, Buenos Aires, Argentina
| | - Laura Scévola
- Buenos Aires University, IBCN-CONICET and Epilepsy Center, Ramos Mejía and El Cruce Hospitals, ENyS-CONICET, Buenos Aires, Argentina
| | | | - Maria E Lozada
- Epilepsy Unit, La Trinidad Medical Center, Caracas, Venezuela
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Asadi-Pooya AA, Alsaadi T, Gigineishvili D, Hingray C, Hosny H, Karakis I, Mesraoua B, Ali MA, Janocko NJ, Elsheikh L, Tarrada A, Yaghmoor BE, Brigo F. Social aspects of life in patients with functional (psychogenic nonepileptic) seizures: An international study. Epilepsy Behav 2020; 113:107534. [PMID: 33254034 DOI: 10.1016/j.yebeh.2020.107534] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To explore various social aspects of life (i.e., employment, education, and driving) in a large sample of patients with functional seizures (FS) living in seven countries from four continents. METHODS In this retrospective study, we investigated adult patients with FS, who were admitted to the epilepsy monitoring units at centers in Iran, Qatar, USA, France, Georgia, Egypt, and United Arab Emirates (UAE). We studied the social aspects of life in the whole cohort. Then, we compared the social aspects of life between different world regions. RESULTS Four hundred and forty patients were included (241 from Iran, 56 from Qatar, 52 from France, 41 from the USA, 19 from UAE, 18 from Egypt, and 13 from Georgia). One hundred and twenty six people (30%) had college education, 142 (33%) were employed, and 101 (28%) drove a motor vehicle in their routine daily lives. People with FS and college education were more likely to report a history of sexual abuse compared with those with a lower education. Patients with no loss of responsiveness with their FS were more likely to be employed. Male patients and patients without aura were more likely to drive a motor vehicle in their routine daily lives. None of the social characteristics of the patients with FS showed significant differences among the two large culturally different groups (Muslim nations vs. Christian nations). CONCLUSION It appears that patients with FS across cultures have significant problems in their social aspects of life.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, PA, USA.
| | - Taoufik Alsaadi
- Department of Neurology- American Center for Psychiatry and Neurology, Dubai, United Arab Emirates.
| | - David Gigineishvili
- Department of Neurology & Neurosurgery, Tbilisi State University, Tbilisi, Georgia.
| | - Coraline Hingray
- Service de neurologie, CHRU de NANCY et Pole universitaire adulte du grand Nancy, CPN, Laxou, France.
| | - Hassan Hosny
- Department of Neurology, Cairo University, Egypt
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, USA.
| | | | - Musab A Ali
- Hamad Medical Corporation and Weill Cornell Medical College, Doha, Qatar.
| | | | - Lubna Elsheikh
- Hamad Medical Corporation and Weill Cornell Medical College, Doha, Qatar.
| | - Alexis Tarrada
- Service de neurologie, CHRU de NANCY et Pole universitaire adulte du grand Nancy, CPN, Laxou, France.
| | - Bassam E Yaghmoor
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
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Alroughani R, Inshasi J, Al-Asmi A, Alkhabouri J, Alsaadi T, Alsalti A, Boshra A, Canibano B, Ahmed SF, Shatila A. Disease-Modifying Drugs and Family Planning in People with Multiple Sclerosis: A Consensus Narrative Review from the Gulf Region. Neurol Ther 2020; 9:265-280. [PMID: 32564333 PMCID: PMC7606397 DOI: 10.1007/s40120-020-00201-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Indexed: 12/15/2022] Open
Abstract
Most disease-modifying drugs (DMDs) are contraindicated in pregnancy. Management of MS is especially challenging for pregnant patients, as withdrawal of DMDs leave the patient at risk of increased disease activity. We, a group of experts in MS care from countries in the Arab Gulf, present our consensus recommendations on the management of MS in these patients. Where possible, a patient planning pregnancy can be switched to a DMD considered safe in this setting. Interferon β now can be used during pregnancy, where there is a clinical need to maintain treatment, in addition to glatiramer acetate. Natalizumab (usually to 30 weeks' gestation for patients with high disease activity at high risk of relapse and disability progression) may also be continued into pregnancy. Cladribine tablets and alemtuzumab have been hypothesised to act as immune reconstitution therapies (IRTs). These drugs provide a period of prolonged freedom from relapses for many patients, but the patient must be prepared to wait for up to 20 months from initiation of therapy before becoming pregnant. If a patient becomes pregnant while taking fingolimod, and requires continued DMD treatment, a switch to interferon β or natalizumab after a variable washout period may be prescribed, depending on the level of disease activity. Women who wish to breastfeed should be encouraged to do so, and interferon β may also be used during breastfeeding. There is a lack of data regarding the safety of using other DMDs during breastfeeding.
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Affiliation(s)
| | - Jihad Inshasi
- Department of Neurology, Rashid Hospital, Dubai, United Arab Emirates
- Dubai Medical College, Dubai Health Authority (DHA), Dubai, United Arab Emirates
| | - Abdullah Al-Asmi
- Neurology Unit, Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Taoufik Alsaadi
- Department of Neurology, American Center of Psychiatry and Neurology, Abu Dhabi, United Arab Emirates
| | | | - Amir Boshra
- Neurology and Immunology Medical Affairs Gulf Region, Merck Serono Middle East FZ LTD, Dubai, United Arab Emirates
| | - Beatriz Canibano
- Department of Neurology (Neuroscience Institute), Hamad Medical Corporation, Doha, Qatar
| | | | - Ahmed Shatila
- Neurology Department, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
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24
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Asadi-Pooya AA, Brigo F, Mesraoua B, Tarrada A, Karakis I, Hosny H, Alsaadi T, Gigineishvili D, Ali MA, Janocko NJ, Elsheikh L, Hingray C. Clinical characteristics of functional (psychogenic nonepileptic) seizures: An international retrospective study. Epilepsy Behav 2020; 111:107197. [PMID: 32540770 DOI: 10.1016/j.yebeh.2020.107197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/01/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE We conducted a multicenter international cross-cultural comparative study to investigate clinical semiology and predisposing factors of functional seizures in a large cohort of patients living in different countries around the world. We hypothesized that semiology and predisposing factors of functional seizures differ between various world regions. METHODS We conducted this retrospective observational study in adults with functional seizures admitted to epilepsy centers in Iran, Qatar, USA, France, Georgia, Egypt, and United Arab Emirates (UAE). We assessed and compared the demographic and clinical seizure characteristics of these patients, according to the patients' reports and review of the ictal recordings during video-electroencephalogram (EEG) monitoring. RESULTS Five hundred nine patients were included (270 from Iran, 74 from Qatar, 63 from France, 43 from the USA, 22 from Egypt, 20 from UAE, and 17 from Georgia). Although all major manifestations of functional seizures (e.g., aura, loss of responsiveness, generalized motor seizures, ictal injury) were seen in all world regions, seizure semiology differed significantly across countries. Auras, ictal urinary incontinence, and ictal injury were more commonly reported by the American patients than patients from other world regions, whereas loss of responsiveness and generalized motor seizures were more frequently observed in the Iranian and American patients than the European and Arab patients. CONCLUSION Semiology of functional seizures seems to vary across various regions of the world; socioeconomic, cultural, ethnic, and religious differences may play an essential role in the modulation of functional seizures semiology across different nations and cultures.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | | | - Alexis Tarrada
- Service de Neurologie, CHRU de NANCY et Pole Universitaire Adulte Du Grand Nancy, CPN, Laxou, France
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, USA.
| | - Hassan Hosny
- Department of Neurology, Cairo University, Egypt
| | - Taoufik Alsaadi
- Department of Neurology, American Center for Psychiatry and Neurology, United Arab Emirates.
| | - David Gigineishvili
- Department of Neurology & Neurosurgery, Tbilisi State University, Tbilisi, Georgia.
| | - Musab A Ali
- Hamad Medical Corporation, Neurosciences Institute, Doha, Qatar.
| | | | - Lubna Elsheikh
- Hamad Medical Corporation, Neurosciences Institute, Doha, Qatar.
| | - Coraline Hingray
- Service de Neurologie, CHRU de NANCY et Pole Universitaire Adulte Du Grand Nancy, CPN, Laxou, France.
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25
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Inshasi JS, Almadani A, Fahad SA, Noori SI, Alsaadi T, Shakra M, Shatila AO, Zein TM, Boshra A. High-efficacy therapies for relapsing-remitting multiple sclerosis: implications for adherence. An expert opinion from the United Arab Emirates. Neurodegener Dis Manag 2020; 10:257-266. [PMID: 32438857 DOI: 10.2217/nmt-2020-0016] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The number of disease-modifying treatments (DMDs) for relapsing-remitting multiple sclerosis has increased. DMDs differ not only in their efficacy and safety/tolerability, but also in the treatment burden of, associated with their initiation, route/frequency of administration, maintenance treatment and monitoring. High-efficacy DMDs bring the prospect of improved suppression of relapses and progression of disability, but may have serious safety issues, and burdensome long-term monitoring. Studies of patient preferences in this area have focused on side effects, efficacy and route of administration. Adherence to DMDs is often suboptimal in relapsing-remitting multiple sclerosis and there is a need to understand more about how the complex therapeutic and administration profiles of newer DMDs interact with these barriers to support optimal adherence to therapy.
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Affiliation(s)
- Jihad Said Inshasi
- MS Section, Rashid Hospital & Dubai Medical College, Dubai Health Authority (DHA), Dubai, UAE
| | - Abubaker Almadani
- Rashid Hospital & Dubai Medical College, Dubai health Authority (DHA), Dubai, UAE
| | - Sarmad Al Fahad
- Neurology Department, Neurospinal Hospital, Baghdad Medical College, Dubai, UAE
| | | | - Taoufik Alsaadi
- Neurology Department, American Center for Psychiatry & Neurology, Dubai, UAE
| | - Mustafa Shakra
- Department of Neurology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
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Kassie S, Ali O, Luthra V, Karrani A, Orr K, Alsaadi T, Arida A. Repetitive transcranial magnetic stimulation in the treatment of major depressive disorder: Preliminary results from the United Arab Emirates. Hamdan Med J 2020. [DOI: 10.4103/hmj.hmj_37_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Yamout B, Sahraian M, Bohlega S, Al-Jumah M, Goueider R, Dahdaleh M, Inshasi J, Hashem S, Alsharoqi I, Khoury S, Alkhawajah M, Koussa S, Al Khaburi J, Almahdawi A, Alsaadi T, Slassi E, Daodi S, Zakaria M, Alroughani R. Consensus recommendations for the diagnosis and treatment of multiple sclerosis: 2019 revisions to the MENACTRIMS guidelines. Mult Scler Relat Disord 2019; 37:101459. [PMID: 31670208 DOI: 10.1016/j.msard.2019.101459] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/11/2019] [Accepted: 10/18/2019] [Indexed: 12/19/2022]
Abstract
With evolving diagnostic criteria and the advent of new oral and parenteral therapies for MS, most current diagnostic and treatment algorithms need revision and updating. The diagnosis of MS relies on incorporating clinical and paraclinical findings to prove dissemination in space and in time, and exclude alternative diseases that can explain the findings at hand. The differential diagnostic workup should be guided by clinical and laboratory red flags to avoid unnecessary tests. Appropriate selection of multiple sclerosis (MS) therapies is critical to maximize patient benefit. The current guidelines review the scientific evidence supporting treatment of acute relapses, radiologically isolated syndrome, clinically isolated syndrome, relapsing remitting MS, and progressive MS. The purpose of these guidelines is to provide practical recommendations and algorithms for the diagnosis and treatment of MS based on current scientific evidence and clinical experience.
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Affiliation(s)
- B Yamout
- Nehme and Therese Tohme MS Center, American University of Beirut Medical Center, Beirut, Lebanon.
| | - M Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - S Bohlega
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - M Al-Jumah
- King Fahad Medical Cit, MOH, Riyadh, Saudi Arabia
| | - R Goueider
- Service de Neurologie, Hôpital Razi, Manouba, Tunis
| | | | - J Inshasi
- Department of Neurology, Rashid Hospital and Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates
| | - S Hashem
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - I Alsharoqi
- Dept of Clinical Neurosciences, Salmaniya Medical Complex, Manama, Bahrain
| | - S Khoury
- Nehme and Therese Tohme MS Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Alkhawajah
- Department of Neurology, The Royal Hospital, Sultanate of Oman
| | - S Koussa
- MS Center- Geitaoui Lebanese University Hospital, Beirut, Lebanon
| | - J Al Khaburi
- Department of Neurology, The Royal Hospital, Sultanate of Oman
| | - A Almahdawi
- Consultant neurologist, neurology unit, Baghdad Teaching Hospital, Medical City Complex, Iraq
| | - T Alsaadi
- American Center for Psychiatry & Neurology- UAE
| | - E Slassi
- Hôpital Cheikh Khalifa Ibn Zaid, Casablanca- Morocco
| | - S Daodi
- Hospital Center Nedir Mohamed, Faculty of Medicine University Mouloud Mammeri Tizi-ouzou Algeria
| | | | - R Alroughani
- Amiri Hospital, Arabian Gulf Street, Sharq, Kuwait
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Alsaadi T, Kassie SA, Servano R. Efficacy and tolerability of perampanel in patients with genetic generalized epilepsy (GGE): A retrospective, single-center study from the United Arab Emirates (UAE). Epilepsy Behav Rep 2019; 12:100330. [PMID: 31517268 PMCID: PMC6737327 DOI: 10.1016/j.ebr.2019.100330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/08/2019] [Accepted: 06/26/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Taoufik Alsaadi
- Department of Neurology, American Center for Psychiatry & Neurology, United Arab Emirates
| | - Seada A Kassie
- Department of Neurology, American Center for Psychiatry & Neurology, United Arab Emirates
| | - Rosario Servano
- Department of Neurology, American Center for Psychiatry & Neurology, United Arab Emirates
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Schiess N, Huether K, Holroyd KB, Aziz F, Emam E, Shahrour T, Szolics M, Alsaadi T. Multiple Sclerosis, Anxiety, and Depression in the United Arab Emirates: Does Social Stigma Prevent Treatment? Int J MS Care 2019; 21:29-34. [PMID: 30833870 DOI: 10.7224/1537-2073.2017-041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Depression rates in the multiple sclerosis (MS) population in the Arab world have rarely been reported despite people with MS generally having higher rates of depression. We examined depression rates in 416 people with MS versus the general population of Abu Dhabi, United Arab Emirates, and their treatment. Methods A retrospective medical record review of 416 people with MS (age range, 16-80 years) followed up at four large government hospitals in Abu Dhabi was conducted to determine the percentage of people with MS diagnosed as having depression or anxiety. Results The depression rate in people with MS (10.8%) was close to that in the general population of Abu Dhabi. The adjusted odds ratios of depression by selected variables showed that there was a significant difference (P = .003) between females and males in reporting depression, with more females reporting depression than males. Greater MS duration was also associated with a higher likelihood of being depressed (P = .025). The anxiety rate in the cohort (4.8%) was lower than that in the general Abu Dhabi population (18.7%). Conclusions The depression rate in people with MS in Abu Dhabi was close to that of the general Abu Dhabi population, but the anxiety rate in people with MS was lower. Explanations for these low rates include possible underreporting by patients and physician factors such as time limitations in busy clinics. Cultural aspects such as strong family support systems and religious factors in this predominantly Muslim population are also possible factors that warrant further investigation.
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Alsaadi T, Kassie S, Mohamed Ali O, Mozahem K, Al Fardan S, Ahmed AM. Psychiatric Comorbidity in Neurological Disorders: Towards a Multidisciplinary Approach to Illness Management in the United Arab Emirates. Front Psychiatry 2019; 10:263. [PMID: 31073293 PMCID: PMC6495369 DOI: 10.3389/fpsyt.2019.00263] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 04/08/2019] [Indexed: 01/03/2023] Open
Abstract
Aim: To determine the prevalence of mood and anxiety disorders in undiagnosed patients attending neurological services, and detect rates of referral to and attendance of psychiatric services. Methods: Depressive symptoms and anxiety were assessed in 395 adult patients with primary diagnoses of neurological disorders. The Patient Health Questionnaire nine-item depression scale (PHQ-9), and Generalized Anxiety Disorder seven-item scale (GAD-7) were administered. Demographic details of the patients were recorded. Referral to and attendance of psychiatric services were recorded for patients scoring within the clinical range of depression and anxiety disorders (scores > 10). Results: There was a 39% prevalence rate of depressive symptoms, 34% rate of anxiety, and 35.4% concurrent rate of both disorders in this cohort. The referral rate to psychiatric services was 33.6%, and attendance rate was 47.8%. There was significant association between severity of psychiatric symptoms and referral to psychiatric services, as well as significant association between comorbid psychiatric symptoms and attendance to psychiatric services. Conclusion: Our results indicate similar prevalence rates of comorbid psychiatric symptoms to studies carried out in the Middle East and North Africa (MENA) region and relatively high attendance and referral rates to psychiatric services. Implications: The results shed light on the clinical profile of patients in this region and support the need for integrated collaborative medical services. Moreover, findings have important implications for health care policies pertaining to resource distribution and funding.
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Affiliation(s)
- Taoufik Alsaadi
- Department of Neurology, Psychiatry, American Center for Psychiatry and Neurology, Abu Dhabi, United Arab Emirates
| | - Seada Kassie
- Department of Neurology, Psychiatry, American Center for Psychiatry and Neurology, Abu Dhabi, United Arab Emirates
| | - Ola Mohamed Ali
- Department of Neurology, Psychiatry, American Center for Psychiatry and Neurology, Abu Dhabi, United Arab Emirates
| | - Khaldoun Mozahem
- Department of Neurology, Psychiatry, American Center for Psychiatry and Neurology, Abu Dhabi, United Arab Emirates
| | - Safana Al Fardan
- Department of Education - Medical Affairs, Shaikh Khalifa Medical Center, Abu Dhabi, United Arab Emirates
| | - Ahmed M Ahmed
- Department of Neurology, Psychiatry, American Center for Psychiatry and Neurology, Abu Dhabi, United Arab Emirates
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Shahrour TM, Mohan S, Siddiq M, Hammasi KE, Alsaadi T. Suicide attempters in Abu Dhabi: Is criminal prosecution associated with patients' guardedness? Death Stud 2018; 42:636-639. [PMID: 29364778 DOI: 10.1080/07481187.2017.1421280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The objective of this study was to examine the relationship between legal status and guardedness in patients who attempted suicide in Abu Dhabi, United Arab Emirates. The consultation-liaison team assessed 355 patients admitted for suicidal/self-injurious behavior, recording their guardedness before knowing whether they were legally charged. Patients who were legally charged for the suicidal act (n = 139) were 1.6 times (p = .03) more guarded in volunteering information than patients who were not legally charged. Legally charging suicide attempters might have a negative impact on risk assessment and psychiatric care.
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Affiliation(s)
- Tarek M Shahrour
- a Consultant Consultation-Liaison Psychiatry, Department of Psychiatry , Shiekh Khalifa Medical City , Abu Dhabi , UAE
| | - Sona Mohan
- b Department of Psychiatry , Shiekh Khalifa Medical City , Abu Dhabi , UAE
| | - Muez Siddiq
- b Department of Psychiatry , Shiekh Khalifa Medical City , Abu Dhabi , UAE
| | - Khadija El Hammasi
- b Department of Psychiatry , Shiekh Khalifa Medical City , Abu Dhabi , UAE
| | - Taoufik Alsaadi
- c Consultant Neurologist , American Center for Neurology and Psychiatry , Abu Dhabi , United Arab Emirates
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Holroyd KB, Aziz F, Szolics M, Alsaadi T, Levy M, Schiess N. Prevalence and characteristics of transverse myelitis and neuromyelitis optica spectrum disorders in the United Arab Emirates: A multicenter, retrospective study. ACTA ACUST UNITED AC 2018; 9:155-161. [PMID: 30090123 DOI: 10.1111/cen3.12458] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objective To determine the epidemiology and characteristics of transverse myelitis (TM) and neuromyelitis optica spectrum disorders (NMOSD) in Abu Dhabi, United Arab Emirates. Methods Retrospective chart review at four large government-run hospitals in Abu Dhabi between 2010 and 2016. Data collected included year of onset, presentation, laboratory results including aquaporin-4 immunoglobulin G (IgG)/myelin oligodendrocyte glycoprotein IgG antibodies and the occurrence of any relapses. Results A total of 46 individuals were identified. Of these, 23 (50%) were Emirati citizens. Within the overall group including pediatrics, the crude prevalence rate for monophasic TM was 1.0 per 100 000, and for NMOSD was 0.34 per 100 000. Incidence rates within the overall group for TM and NMOSD were 0.18 per 100 000 and 0.05 per 100 000, respectively. For Emirati citizens aged ≥20 years, the prevalence rate for monophasic TM was 2.46 per 100 000 and 1.76 per 100 000 for NMOSD, and the incidence was 0.57 per 100 000 and 0.17 per 100 000, respectively. The incidence of monophasic TM and NMOSD within the Emirati pediatric population (aged ≤19 years) was 0.18 per 100 000 and 0.06 per 100 000, respectively. The mean age of onset for monophasic TM was 36 years, and for NMOSD was 43 years. Nine patients had a positive aquaporin-4 IgG or anti-myelin oligodendrocyte glycoprotein IgG antibody result. Of the 30 participants with available laboratory cerebrospinal fluid analysis, 36.6% had elevated white blood counts (>5.0 × 106/L), and 43% had elevated protein levels. A total of 19 participants had documentation of oligoclonal bands or IgG index, and just four (21%) had either oligoclonal bands or elevated IgG index. Conclusion The present study describes the epidemiology and characteristics of TM and NMOSD among populations in Abu Dhabi. The adult prevalence rate for Emirati citizens was 2.46 per 100 000 for monophasic TM, and 1.76 per 100 000 for NMOSD. The overall incidence was 0.18 per 100 000 and 0.05 per 100 000, respectively.
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Affiliation(s)
- Kathryn B Holroyd
- Partners Neurology Residency, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Faisal Aziz
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
| | - Miklos Szolics
- Department of Neurology, Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates
| | - Taoufik Alsaadi
- Neurology Department, American Center for Psychiatry and Neurology, Al Ain, Abu Dhabi, United Arab Emirates
| | - Michael Levy
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicoline Schiess
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Ismail FY, Gordon-Lipkin E, Huether K, Blair I, Szólics M, Alsaadi T, Aziz F, Suleiman J, Schiess N. Pediatric Multiple Sclerosis in the United Arab Emirates: Characteristics From a Multicenter Study and Global Comparison. J Child Neurol 2018; 33:422-427. [PMID: 29607711 DOI: 10.1177/0883073818759103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 11/15/2022]
Abstract
We delineate the clinical characteristics, incidence, and prevalence of pediatric-onset multiple sclerosis in Abu Dhabi, United Arab Emirates, from 2010 to 2014. Eighty-two patients (65% female) were identified. Fifty-three (64.6%) were Emiratis (45 from Abu Dhabi and 8 from 5 other emirates) and 29 were expatriates. Mean age of onset was 15.9 years overall, 15.3 years in males and 16.3 years in females. Patients with onset before age 12 years presented with visual symptoms while those with onset after age 12 years presented with a mixture of visual, motor and sensory symptoms. Interferon beta-1a was the most frequently used disease-modifying therapy (48%). In Abu Dhabi Emirati nationals, the age- and sex-adjusted prevalences were 26/100 000 for males and 36/100 000 for females. The total incidence in Emirati nationals from 2010 to 2014 was 2.3/100 000 for ages 10 to 14 years and 7.2/100 000 for ages 15 to 19 years. By comparison with international cohorts, the incidence of pediatric-onset multiple sclerosis in Abu Dhabi is higher whereas gender distribution is similar.
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Affiliation(s)
- Fatima Y Ismail
- 1 Department of Neurology and Developmental Medicine, The Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,2 Department of Pediatrics, United Arab Emirates University, Al Ain, UAE
| | - Eliza Gordon-Lipkin
- 1 Department of Neurology and Developmental Medicine, The Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | - Iain Blair
- 4 Institute of Public Health United Arab Emirates University, Al Ain, UAE
| | | | - Taoufik Alsaadi
- 6 American Center for Psychiatry and Neurology, Abu Dhabi, UAE
| | - Faisal Aziz
- 4 Institute of Public Health United Arab Emirates University, Al Ain, UAE
| | - Jehan Suleiman
- 2 Department of Pediatrics, United Arab Emirates University, Al Ain, UAE.,7 Division of Neurology, Department of Pediatrics, Tawam Hospital, Al Ain, UAE
| | - Nicoline Schiess
- 8 Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
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Alsaadi T, Hammasi KE, Shahrour TM, Shakra M, Turkawi L, Nasreddine W, Kassie S, Raoof M. Depression and anxiety as determinants of health-related quality of life in patients with multiple sclerosis - United Arab Emirates. Neurol Int 2017; 9:7343. [PMID: 29619159 PMCID: PMC5865303 DOI: 10.4081/ni.2017.7343] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 08/04/2017] [Accepted: 10/11/2017] [Indexed: 12/16/2022] Open
Abstract
To study the impact of depression and anxiety on health-related quality of life (HRQOL) in patients with multiple sclerosis (pwMS) in the UAE. All consecutive patients attending the MS clinic over a fourmonth period, October 2014 through February 2015, at Sheikh Khalifa Medical city (SKMC) were asked to complete The World Health Organization quality of life abbreviated scale (WHOQOL-BREF), the Patient Health Questionnaire nine-item (PHQ-9) depression scale, and Generalized Anxiety Disorder seven-item (GAD-7) scale. These last two scales were used to screen for depression and anxiety disorders respectively. The study looked at significant variables associated with HRQOL, using multivariate analysis. Eighty patients were enrolled in the study. Both anxiety and depression had a strong positive correlation with HRQOL in univariate analysis. However, depression was the strongest predictor of HRQOL in the patients using linear multi-regression analysis. Screening and timely treatment of both anxiety and depression in MS patients should be a recommended policy when managing pwMS to improve their optimal care and ensure better quality of life.
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Affiliation(s)
| | | | - Tarek M. Shahrour
- Department of Psychiatry, Sheikh Khalifa Medical City (SKMC), Abu Dhabi
| | | | - Lamya Turkawi
- Department of Neurology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Wassim Nasreddine
- Department of Neurology, American University of Beirut-Medical Center, Lebanon
| | - Seada Kassie
- American Center for Psychiatry and Neurology, Abu Dhabi
| | - Mufeed Raoof
- Department of Psychiatry, Sheikh Khalifa Medical City (SKMC), Abu Dhabi
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Alsaadi T, Kassie S, El Hammasi K, Shahrour TM, Shakra M, Turkawi L, Nasreddine W, Raoof M. Potential factors impacting health-related quality of life among patients with epilepsy: Results from the United Arab Emirates. Seizure 2017; 53:13-17. [PMID: 29096164 DOI: 10.1016/j.seizure.2017.10.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 08/04/2017] [Revised: 10/18/2017] [Accepted: 10/21/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE to investigate potential factors impacting HRQOL among PWE at a medical facility in the UAE. METHODS Depression, anxiety, and health-related quality of life were assessed in 160 adult patients with epilepsy from September 2014 to January 2015 at Sheikh Khalifa Medical City (SKMC). The World Health Organization Quality of Life abbreviated scale (WHOQOL-BREF), the Patient Health Questionnaire nine-item (PHQ-9) depression scale, and Generalized Anxiety Disorder seven-item (GAD-7) scale were administered. Demographic details including psychosocial factors were also obtained. Clinical details including seizure freedom, epilepsy type, epilepsy duration, and magnetic resonance imaging (MRI) results were recorded. Multivariate analysis was used to look at significant variables associated with HRQOL. RESULTS Depression, anxiety, seizure freedom, and the use of anti-depressants had significant positive correlation with HRQOL in univariate analysis. However, depression, followed by seizure freedom, had the strongest association with HRQOL in a multivariate regression analysis. CONCLUSION Depression and seizure freedom, followed by anxiety and anti-depressants use, were significantly correlated with HRQOL. These results underscore the importance of screening for psychiatric comorbidities in patients with epilepsy. IMPLICATIONS Screening for comorbid psychiatric disorders should be an essential component of the standard of care, and incorporated in the treatment plan for all patients with epilepsy. Factors contributing to psychiatric symptoms among PWE, such as maladaptive illness perceptions, non-adherence to anti-epileptic drugs (AED), and social stigma should be carefully addressed to achieve an optimal health-care plan.
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Affiliation(s)
- Taoufik Alsaadi
- American Center for Psychiatry & Neurology, Abu Dhabi, United Arab Emirates.
| | - Seada Kassie
- American Center for Psychiatry & Neurology, Abu Dhabi, United Arab Emirates
| | - Khadija El Hammasi
- Department of Psychiatry, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Tarek M Shahrour
- Department of Psychiatry, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Mustafa Shakra
- Department of Neurology, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Lamya Turkawi
- Department of Neurology, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Wassim Nasreddine
- Department of Neurology, American University of Beirut-Medical center 7, Lebanon, Lebanon
| | - Mufeed Raoof
- Department of Psychiatry, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
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Schiess N, Holroyd KB, Abdul Aziz FA, Huether K, Szolics M, Alsaadi T. The Rapidly Changing Landscape of Multiple Sclerosis Immunomodulatory Therapy: A Retrospective Chart Review in the United Arab Emirates. ACTA ACUST UNITED AC 2017. [DOI: 10.4172/2376-0389.1000203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Schiess N, Huether K, Fatafta T, Fitzgerald KC, Calabresi PA, Blair I, Alsaadi T, Szolics M. How global MS prevalence is changing: A retrospective chart review in the United Arab Emirates. Mult Scler Relat Disord 2016; 9:73-9. [PMID: 27645349 DOI: 10.1016/j.msard.2016.07.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 04/13/2016] [Revised: 06/21/2016] [Accepted: 07/06/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS) is an autoimmune disorder leading to central nervous system inflammation. Traditionally, reported MS prevalence rates in the Middle East are low. Few studies include age/sex standardization giving an unreliable estimate of regional prevalence. OBJECTIVE to determine the prevalence, incidence and characteristics of MS in Abu Dhabi, United Arab Emirates. METHODS A retrospective chart review was conducted at the four largest hospitals in Abu Dhabi Emirate between 2010 and 2014. Data collected included MS type, age and symptoms at onset, expanded disability status scale, treatment, laboratory findings and family history. RESULTS 510 patients were identified consisting of 318 (62.2%) Emiratis and 192 (37.6%) expatriates. Total crude prevalence rate was 18/100,000 (95% CI: 10-30/100,000). Crude prevalence rate in Emiratis was 57.09 (95% CI:50 to 63/100,000) but increased to 64.44 (95% CI: 57 to 72/100,000) when age standardized. Age-standardized incidence rate in Emiratis was 6.0 MS cases per 100,000 person-years (95% CI: 5.5 to 6.5 cases per 100,000 person-years). CONCLUSION At 64.44/100,000, the Abu Dhabi Emirati population has one of the highest, most reliable prevalence rate on the Arab peninsula. Age/sex standardized prevalence rates, uncommonly reported in the Middle East, should be standard for all prevalence studies.
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Affiliation(s)
- Nicoline Schiess
- Johns Hopkins University, Neurology, 600 N. Wolfe St. Meyer 6-113, Baltimore, MD 21287, United States.
| | - Katherine Huether
- Johns Hopkins University, Neurology, 600 N. Wolfe St. Meyer 6-113, Baltimore, MD 21287, United States
| | - Taghreed Fatafta
- Johns Hopkins University, Neurology, 600 N. Wolfe St. Meyer 6-113, Baltimore, MD 21287, United States
| | - Kathryn C Fitzgerald
- Johns Hopkins University, Neurology, 600 N. Wolfe St. Meyer 6-113, Baltimore, MD 21287, United States
| | - Peter A Calabresi
- Johns Hopkins University, Neurology, 600 N. Wolfe St. Meyer 6-113, Baltimore, MD 21287, United States
| | - Iain Blair
- Johns Hopkins University, Neurology, 600 N. Wolfe St. Meyer 6-113, Baltimore, MD 21287, United States
| | - Taoufik Alsaadi
- Johns Hopkins University, Neurology, 600 N. Wolfe St. Meyer 6-113, Baltimore, MD 21287, United States
| | - Miklos Szolics
- Johns Hopkins University, Neurology, 600 N. Wolfe St. Meyer 6-113, Baltimore, MD 21287, United States
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Alameri M, Shakra M, Alsaadi T. Fatal coma in a young adult due to late-onset urea cycle deficiency presenting with a prolonged seizure: a case report. J Med Case Rep 2015; 9:267. [PMID: 26593089 PMCID: PMC4655488 DOI: 10.1186/s13256-015-0741-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/21/2015] [Indexed: 11/25/2022] Open
Abstract
Introduction Unexplained hyperammonemic coma in adults can be a medical dilemma in the absence of triggering factors and known comorbidities. Ornithine transcarbamylase deficiency presents most commonly with hyperammonemic coma. Although a rare disorder, ornithine transcarbamylase deficiency is the most common of the urea cycle disorders, which can occur both in children, and less commonly, in adults. The urea cycle disorder is usually acquired as an X-linked trait, and very rarely, similar to our reported case, may be acquired as a “new” mutation. Mutations that lead to later-onset presentations may lead to life-threatening disease and may be unrecognized, particularly when the first clinical symptoms occur in adulthood. Case presentation We report the case of a previously healthy 17-year-old white man who developed a prolonged seizure and a rapid decline in mental status leading to coma over a 3-day period. Analysis of the OTC gene showed a 119G variant, which was identified in exon 2 of the OTC gene by sequencing. Conclusions A diagnosis of ornithine transcarbamylase deficiency should be considered in adult patients who present with unexplained hyperammonemic coma and for all adult patients presenting with cryptogenic new-onset seizure and laboratory finding of elevated blood ammonia levels. This reported case highlights the importance of early recognition of this potentially reversible cause of life-threatening encephalopathy, as timely recognition and appropriate treatment can be lifesaving.
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Affiliation(s)
- Majid Alameri
- Department of Neurology, Sheikh Khalifa Medical City (SKMC), P.O. Box 51900, Abu Dhabi, United Arab Emirates.
| | - Mustafa Shakra
- Department of Neurology, Sheikh Khalifa Medical City (SKMC), P.O. Box 51900, Abu Dhabi, United Arab Emirates.
| | - Taoufik Alsaadi
- Department of Neurology, Sheikh Khalifa Medical City (SKMC), P.O. Box 51900, Abu Dhabi, United Arab Emirates.
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Alsaadi T, El Hammasi K, Shahrour TM, Shakra M, Turkawi L, Almaskari B, Diab L, Raoof M. Prevalence of depression and anxiety among patients with epilepsy attending the epilepsy clinic at Sheikh Khalifa Medical City, UAE: A cross-sectional study. Epilepsy Behav 2015; 52:194-9. [PMID: 26448591 DOI: 10.1016/j.yebeh.2015.09.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 03/16/2015] [Revised: 08/30/2015] [Accepted: 09/03/2015] [Indexed: 11/28/2022]
Abstract
Depression and anxiety are highly prevalent in patients with epilepsy (PWE), with prevalence rates ranging from 20% to 55%. Unfortunately, the rates, patterns, and risk factors have not been well studied in the Middle East and, to our knowledge, have not been studied at all in the UAE. We screened 186 patients attending an epilepsy clinic using standardized screening tools to determine the rates of both depression and anxiety and compared these rates with that of age- and sex-matched controls. Almost one-third of our patients scored in the depression and anxiety ranges, which was significantly higher compared with the age- and sex-matched controls. Using a multiregression model, none of the studied variables were associated with an increased risk of having either disorder. Depression or anxiety symptoms independently and significantly increased the risk of association with the other disorder. Almost two-thirds of patients with depression and anxiety were not prescribed antidepressant or antianxiety medications.
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Affiliation(s)
- Taoufik Alsaadi
- Department of Neurology, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates.
| | - Khadija El Hammasi
- Department of Psychiatry, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Tarek M Shahrour
- Department of Psychiatry, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Mustafa Shakra
- Department of Neurology, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Lamya Turkawi
- Department of Neurology, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Buthaina Almaskari
- Department of Psychiatry, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Lina Diab
- Department of Neurology, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Mufeed Raoof
- Department of Psychiatry, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
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Alsaadi T, El Hammasi K, Shahrour TM. Does pyridoxine control behavioral symptoms in adult patients treated with levetiracetam? Case series from UAE. Epilepsy Behav Case Rep 2015; 4:94-5. [PMID: 26543816 PMCID: PMC4588452 DOI: 10.1016/j.ebcr.2015.08.003] [Citation(s) in RCA: 9] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 08/18/2015] [Accepted: 08/21/2015] [Indexed: 11/25/2022]
Abstract
Behavioral symptoms are known side effects of levetiracetam. Previous case series in children and adolescents have demonstrated the potential effect of pyridoxine in ameliorating these symptoms. We retrospectively reviewed the charts of 51 patients treated with pyridoxine to control agitation and irritability following the introduction of levetiracetam. These symptoms were relieved in 34 patients (66.6%). Seventeen patients did not appear to benefit from this supplementation. This preliminary study suggests that pyridoxine might be an effective option across all ages for patients suffering from levetiracetam-induced behavioral side effects.
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Affiliation(s)
- Taoufik Alsaadi
- Department of Neurology, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Khadija El Hammasi
- Department of Psychiatry, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Tarek M Shahrour
- Department of Psychiatry, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
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Alsaadi T, Shakra M, Turkawi L, Hamid J. VNS terminating refractory nonconvulsive SE secondary to anti-NMDA encephalitis: A case report. Epilepsy Behav Case Rep 2015; 3:39-42. [PMID: 26005636 PMCID: PMC4436507 DOI: 10.1016/j.ebcr.2015.02.003] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 02/20/2015] [Indexed: 01/17/2023]
Abstract
Anti-NMDA receptor encephalitis (ANRE) has been previously reported as a rare cause of nonconvulsive status epilepticus (NCSE). Vagus nerve stimulation (VNS) is generally considered as a palliative treatment for patients with drug-resistant partial-onset epilepsy. Here, we report a case of refractory NCSE that was terminated after vagus nerve stimulator implantation. To our knowledge, similar cases have not been reported previously.
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Affiliation(s)
- Taoufik Alsaadi
- Department of Neurology, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
- Corresponding author.
| | - Mustafa Shakra
- Department of Neurology, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Lamya Turkawi
- Department of Neurology, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Jassin Hamid
- Department of Medicine, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
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Alsaadi T, Shahrour TM. Language lateralization in a patient with temporal lobe epilepsy and callosal agenesis. Epilepsy Behav Case Rep 2015; 3:1-3. [PMID: 25737961 PMCID: PMC4338855 DOI: 10.1016/j.ebcr.2014.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 07/14/2014] [Indexed: 11/06/2022]
Abstract
The corpus callosum has been proposed as a mechanism of interhemispheric inhibition that allows language dominance to develop [1]. Callosal agenesis or dysgenesis provides a test of this hypothesis, as patients lacking a normal corpus callosum should also lack normal language lateralization [2]. We report pre- and postoperative functional magnetic resonance imaging (fMRI) and neuropsychological testing in a patient with partial callosal agenesis who underwent a right temporal lobectomy for medically refractory seizures.
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Yamout B, Alroughani R, Al-Jumah M, Goueider R, Dahdaleh M, Inshasi J, Hashem S, Alsharoqi I, Sahraian M, Khoury S, Alkawi Z, Koussa S, Zakaria M, Al Khaburi J, Alsaadi T, Bohlega S. Consensus recommendations for the diagnosis and treatment of multiple sclerosis: the Middle East North Africa Committee for Treatment and Research In Multiple Sclerosis (MENACTRIMS). Curr Med Res Opin 2015; 31:1349-61. [PMID: 25946578 DOI: 10.1185/03007995.2015.1047750] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
With evolving diagnostic criteria and the advent of new oral and parenteral therapies for MS, most current diagnostic and treatment algorithms need re-evaluation and updating. The diagnosis of MS relies on incorporating clinical and paraclinical findings to prove dissemination in space and in time, and exclude alternative diseases that can explain the findings at hand. The differential diagnostic workup should be guided by clinical and laboratory red flags to avoid unnecessary tests. Appropriate multiple sclerosis (MS) therapy selection is critical to maximize patient benefit. The current guidelines review the scientific evidence supporting treatment of acute relapses, radiologically isolated syndrome, clinically isolated syndrome, relapsing remitting MS, secondary progressive MS, and primary progressive MS. The purpose of these guidelines is to provide practical recommendations and algorithms for the diagnosis and treatment of MS based on current scientific evidence and clinical experience.
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Affiliation(s)
- B Yamout
- MS Center, American University of Beirut Medical Center , Beirut , Lebanon
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Alsaadi T, Alkaddour AR, Shahrour TM, Shakra M, Turkawi L, Shatila A. Midwakh-induced seizures: case series from UAE. Epilepsy Behav 2014; 39:85-7. [PMID: 25233482 DOI: 10.1016/j.yebeh.2014.08.132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 08/08/2014] [Revised: 08/22/2014] [Accepted: 08/23/2014] [Indexed: 10/24/2022]
Abstract
Drug-induced seizures are rare causes of hospital admissions (Coleman, 2004). Various classes of drugs are reported to induce seizures either directly, due to their epileptogenic potential or due to drug withdrawal effect, or indirectly, due to systemic and CNS-related side effects (Thundiyil et al., 2011). Midwakh is commonly used among young Emiratis. However, its CNS-related adverse effects are not well studied. We report seven consecutive patients with a history of seizures provoked by smoking midwakh and a negative workup for epilepsy. Six of these patients had no further seizures after they had agreed to discontinue smoking midwakh.
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Affiliation(s)
- Taoufik Alsaadi
- Department of Neurology, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates.
| | - Abdul Razzak Alkaddour
- Department of Cardiology, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Tarek M Shahrour
- Department of Psychiatry, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Mustafa Shakra
- Department of Neurology, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Lamya Turkawi
- Department of Neurology, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Ahmed Shatila
- Department of Neurology, Mafraq Hospital, Abu Dhabi, United Arab Emirates
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Alsaadi T, Shahrour TM. Psychogenic Nonepileptic Seizures: What a Neurologist Should Know. Health (London) 2014. [DOI: 10.4236/health.2014.616241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Yamout B, Alroughani R, Al-Jumah M, Khoury S, Abouzeid N, Dahdaleh M, Alsharoqi I, Inshasi J, Hashem S, Zakaria M, ElKallab K, Alsaadi T, Tawfeek T, Bohlega S. Consensus guidelines for the diagnosis and treatment of multiple sclerosis. Curr Med Res Opin 2013; 29:611-21. [PMID: 23514115 DOI: 10.1185/03007995.2013.787979] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The diagnosis of multiple sclerosis (MS) is dependent on the presence of clinical and paraclinical evidence demonstrating dissemination of central nervous system lesions in both space and time, as well as the exclusion of other disorders. Diagnostic criteria were originally promulgated in 1965 by the Schumacher committee and modified subsequently by the Poser committee to include paraclinical evidence. The most recent criteria are the 2010 modifications of the 2001 McDonald criteria, which are focused on making an earlier diagnosis of MS. This article provides guidelines, derived from clinical experience as well as evidence-based medicine, for the diagnosis and management of MS with special emphasis on practices in the Middle East.
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Affiliation(s)
- B Yamout
- American University of Beirut Medical Center, Beirut, Lebanon.
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Alsaadi T, Zamel K, Sameer A, Fathalla W, Koudier I. Depressive disorders in patients with epilepsy: Why should neurologists care? Health (London) 2013. [DOI: 10.4236/health.2013.56a1003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bohlega S, Alsaadi T, Amir A, Hosny H, Karawagh AM, Moulin D, Riachi N, Salti A, Shelbaya S. Guidelines for the Pharmacological Treatment of Peripheral Neuropathic Pain: Expert Panel Recommendations for the Middle East Region. J Int Med Res 2010; 38:295-317. [DOI: 10.1177/147323001003800201] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Neuropathic pain (NeP) has been the focus of extensive basic and clinical research over the past 20 years. This has led to an increased understanding of underlying pathophysiological mechanisms and the development of new therapeutic agents, as well as a clearer definition of the role of established medications. To date there are no published treatment guidelines for NeP in the Middle East. A multidisciplinary panel of Middle East and international experts met to review critically and reach a consensus on how best to apply evidence-based guidelines for the treatment of NeP (mainly peripheral NeP) in the Middle East. The expert panel recommended pregabalin, gabapentin and secondary amine tricyclic antidepressants (nortriptyline and desipramine) as first-line treatments for peripheral NeP. Serotonin-norepinephrine reuptake inhibitor antidepressants, tramadol and controlled-release opioid analgesics were recommended as second-line treatments. There is a need to increase diagnostic awareness of NeP, use validated screening questionnaires and undertake more treatment research in the Middle East region.
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Affiliation(s)
- S Bohlega
- King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - T Alsaadi
- Sheikh Kalifa Medical City, Abu Dhabi, United Arab Emirates
| | - A Amir
- International Medical Centre, Jeddah, Kingdom of Saudi Arabia
| | - H Hosny
- Cairo University, Cairo, Egypt
| | - AM Karawagh
- King Abdul-Aziz Medical City, Jeddah, Kingdom of Saudi Arabia
| | - D Moulin
- University of Western Ontario, London, Ontario, Canada
| | - N Riachi
- University Medical Centre, Rizk Hospital and the Lebanese American University, Beirut, Lebanon
| | - A Salti
- Zayed Military Hospital, Abu Dhabi, United Arab Emirates
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Alsaadi T. The role of vagus nerve stimulation in the management of epilepsy. Rev Neurol (Paris) 2007. [DOI: 10.1016/s0035-3787(07)90428-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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