The PR of epilepsy in Saudi Arabs is within the range of the values reported in most communities. The causes of symptomatic epilepsies revealed a predominance of perinatal and inherited factors. Isolated and non-convulsive seizures were probably under-recognized due to various social and cultural factors as well as to lack of sensitivity of the questionnaire for non-convulsive seizures.

We studied 89 MS patients comprising 38 males and 51 females seen over a 10-year period. The hospital frequency was 25/100,000 patients. The diagnosis was mainly clinical and was supported by neuroimaging, cerebrospinal fluid analysis and neurophysiological tests. Sixty-five patients (73%) were Saudis and the peak age of onset was in the third decade. Fifty-two patients (58.4%) had clinically definite MS, 17 (19.1%) had laboratory-supported definite MS, 15 (16.9%) were clinically probable MS cases and the remaining 5 (5.6%) had laboratory-supported probable MS. The mean age at onset of Saudi patients (25.9 years) was lower than that of the non-Saudis (29.4 years; p < 0.001). Involvement of the pyramidal system was the commonest mode of presentation. The clinical course was relapsing-remitting in 60.7%, progressive-relapsing in 20.2% and primary progressive in 19.1%. The number of systems involved was significantly associated with the duration of disease (p < 0.001). The demographic features and the variability of clinical presentation of Saudi MS patients is similar to the results from neighbouring countries. Combination of clinical features and paraclinical tests is essential for accurate determination of extent of dissemination and for unmasking clinically silent lesions.

S Al-Rajeh, A Ogunniyi, A Awada, A Daif, R Zaidan, Preliminary Assessment of an Arabic Version of the MiniMental State Examination. 1999; 19(2): 150-152 The Mini-Mental State Examination (MMSE) is one of the most widely used instruments for quantitative assessment of cognitive functions and for dementia screening.1,2 It assesses many cognitive domains, including orientation, memory, language, calculation and visual construction. The test, however, shows educational as well as cultural bias, and appears to be more suited to Western culture. [2][3][4] The use of the MMSE in other cultures, therefore, entails translation into the specific languages, modification and/or substitution of some of the items with culturally relevant ones, and pilot-testing these for reliability, sensitivity and specificity. There are many versions and translations of the MMSE, including Chinese, German, Spanish and Nigerian, which have been used for studies in the respective cultures. [4][5][6][7] An Arabic version of the MMSE was developed and pilot-tested on Saudi patients. The results are presented in this report. Materials and MethodsThe MMSE was translated into the Arabic language, with many items left unchanged from the original version. The names of the area of the Kingdom and its location were substituted for the name of the country and the particular state, which appear in the original version. Date (a popular palm produce), chair and money, were the three items most often used. We used serial subtraction of 3s from 100 for assessing calculation, attention and concentration. We omitted spelling "world" backwards because the concept appeared difficult in a predominantly illiterate population. The expression "no ifs, ands or buts" was replaced by an Arabic phrase. The Arabic version produced was then translated back into English to ensure consistency of the items. The questionnaire was then administered by the same interviewer to 33 subjects, comprising 27 males and 6 females, who volunteered to take part in the study. The participants were mainly relations of inpatients at the King Khalid University Hospital, Riyadh (KKUH), who had no evidence of central nervous system dysfunction and were not on medications that could depress cognitive function or alertness. The responses were recorded as either correct or incorrect. The educational status of the individuals was obtained at the end of the administration of the questionnaire. Individuals who had not attended school or had spent less than six years in school were regarded as uneducated.Using sequential analysis, the questionnaire was administered by the same interviewer to four clinically diagnosed demented patients (based on DSM-IV criteria) 8 being managed at KKUH, for the determination of its psychometric properties. The dementia diagnoses were vascular (two cases), probable Alzheimer's disease (one case) and dementia associated with meningioma (one case). The patients included three females and one male, with a mean age of 69.8±11.2 years (range, 54-80 years), who were uned...

The findings agree with the reported prevalence of 10% to 12% in other communities in the Kingdom of Saudi Arabia, but lower than the rates in Western countries. The lower rates are probably related to sociocultural factors.

No abstract

ObjectiveHypertension is the most important modifiable risk factor for stroke globally. We hypothesised that country-income level variations in knowledge, detection and treatment of hypertension may contribute to variations in the association of blood pressure with stroke.MethodsWe undertook a standardised case-control study in 32 countries (INTERSTROKE). Cases were patients with acute first stroke (n=13 462) who were matched by age, sex and site to controls (n=13 483). We evaluated the associations of knowledge, awareness and treatment of hypertension with risk of stroke and its subtypes and whether this varied by gross national income (GNI) of country. We estimated OR and population attributable risk (PAR) associated with treated and untreated hypertension.ResultsHypertension was associated with a graded increase in OR by reducing GNI, ranging from OR 1.92 (99% CI 1.48 to 2.49) to OR 3.27 (2.72 to 3.93) for highest to lowest country-level GNI (p-heterogeneity<0.0001). Untreated hypertension was associated with a higher OR for stroke (OR 5.25; 4.53 to 6.10) than treated hypertension (OR 2.60; 2.32 to 2.91) and younger age of first stroke (61.4 vs 65.4 years; p<0.01). Untreated hypertension was associated with a greater risk of intracerebral haemorrhage (OR 6.95; 5.61 to 8.60) than ischaemic stroke (OR 4.76; 3.99 to 5.68). The PAR associated with untreated hypertension was higher in lower-income regions, PAR 36.3%, 26.3%, 19.8% to 10.4% by increasing GNI of countries. Lifetime non-measurement of blood pressure was associated with stroke (OR 1.80; 1.32 to 2.46).ConclusionsDeficits in knowledge, detection and treatment of hypertension contribute to higher risk of stroke, younger age of onset and larger proportion of intracerebral haemorrhage in lower-income countries.

ABSTRACT:Objective:The objective of this study was to evaluate the pattern of cognitive disturbances in Nigerian Africans with newly diagnosed epilepsy, prior to onset of drug therapy.Methods:A total of 60 consecutive patients (mean age 31.6 ± 17.4, range 14 - 55 years) presenting with a clinical diagnosis of epilepsy were recruited for the study. Sixty healthy volunteers without a history of epilepsy and who were age-, sex- and level of education matched with the epileptic patients, were recruited as controls. The administration of cognitive tests was done with the FePsy computerized neuropsychological test battery. The tests administered were the visual and auditory reaction times, the continuous performance test and the recognition memory tests to assess mental speed, attention and memory respectively. The means of the cognitive performances of the epileptic patients and controls were statistically compared.Results:Epileptic patients performed worse than the controls across the spectrum of cognitive tasks assessed (P = 0.00001; P < 0.025), with the exception of the β parameter (response bias) of the vigilance test (P = 0.488; P> 0.025).Conclusions:The cognitive impairments of short-term memory, psychomotor speed and sustained attention observed in this study are similar to those reported in the literature for patients with epilepsy. The results of this study will be useful in the counseling of patients on their educational, social and vocational needs.

154Neuropsychological impairments in HIV/AIDS have been extensively researched and reported in developed countries, usually reflecting the prominence of initial sub-cortical involvement and characterized by memory loss (usually impaired retrieval), general slowing of psychomotor speed and thought processes and impaired manipulation of acquired knowledge. 1,2 Memory impairment, both verbal and non-verbal, is characteristic of HIV-associated dementia. 3 During the early years of the HIV epidemic, cognitive symptoms were thought to be common even during the initial ABSTRACT: Background: Memory impairment, usually impaired retrieval of information, has been described in HIV/AIDS, especially among those with severe illness. Neuro-cognitive disturbances in HIV/AIDS have been linked to poor quality of life and medication adherence. This prospective, case-control study was designed to assess the verbal and non-verbal memory as well as the attention abilities of Nigerian Africans with HIV/AIDS and correlate their performances with their CD4+ T lymphocytes (CD4+) counts. Methods: A total of 288 randomly selected subjects, comprising 96 HIV-positive symptomatic patients, 96 HIV-positive asymptomatic patients and 96 HIV-negative controls, participated in the study. The subjects were age-, sex-, and level of education matched. The Recognition Memory Test and Choice Reaction Time tasks, components of the computer-assisted neuropsychological tests battery-the Iron Psychology 'FePsy' were used for cognitive assessments. Results: The mean memory scores of the HIV-positive asymptomatic subjects did not differ significantly from the controls (p>0.05) but the HIV-positive symptomatic subjects' scores were significantly lower than the controls (p<0.05). Both HIV-positive groups had psychomotor slowing and impaired attention (p<0.05). The HIVpositive subjects with CD4+ counts <200/µl and between 200 and 499/µl had significant memory impairment (p<0.001 and p<0.001 respectively) but there was no significant impairment among those with count ≥500/µl. Impaired ability for sustained attention was however present irrespective of the CD4+ level relative to controls (p<0.001). Conclusions: We concluded that there was no significant memory disturbance among HIV-positive asymptomatic subjects despite the presence of impaired attention and psychomotor slowing, and that the severity of immune suppression (as indicated by the CD4+ T lymphocytes count) is a strong determinant of cognitive decline in HIV/AIDS. RÉSUMÉ: Étude prospective cas-témoin du fonctionnement mnésique chez les patients atteints du VIH/SIDA. Contexte : Une atteinte de la mémoire, habituellement de la récupération de l'information, a été décrite chez les patients atteints du VIH/SIDA, spécialement chez ceux dont la maladie est sévère. Les perturbations neuro-cognitives dans le VIH/SIDA ont été associées à une faible qualité de vie et de fidélité à la médication. . Il n'existait pas d'atteinte significative chez ceux dont le décompte était ? 500/Ìl. Cependant, ils avaient un déf...