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Background: Stroke presents as the second most prominent factor contributing to global mortality. Immediate brain imaging can be valuable for assessing functional recovery potential. This study investigated the association between Alberta Stroke Program Early CT Score (ASPECTS) and functional outcomes in patients with left and right-hemisphere strokes. Methods: A prospective cohort study was conducted in July-Dec2 022, at a tertiary care hospital in Karachi including patients of either gender presenting within 2 days of stroke while excluding posterior circulation strokes, TIA & unwilling patients using a non-probability consecutive sampling technique. A total of 152 patients with acute ischemic stroke involving anterior circulation were analyzed and patients were categorized into two groups: the left hemisphere group (n=76) and the right hemisphere group (n=76) accordingly. ASPECTS scores were calculated from brain CT scans, while functional outcomes were measured using the modified Rankin Scale (mRS) at the three-month mark. Descriptive analysis and chi-square test were applied using SPSS vr25. Results: Patients (n=152) had a mean age of 61.75 ± 13 years, with males comprising 67% of the cohort. ASPECTS scores were notably higher in left hemisphere strokes (median 9, IQR 2) than right hemisphere strokes (median 8, IQR 3) (p=0.036). Higher ASPECTS scores (≥7) correlated with improved outcomes (mRS ≤2) in both hemispheres. There was no statistically significant difference in both groups’ functional outcomes (p=0.182). Conclusion: ASPECTS predicts functional outcomes in acute ischemic strokes equally well regardless of the affected hemisphere.

Background and Purpose: Coronavirus disease 2019 (CO­VID-19) has an increased propensity for systemic hypercoagulability and thromboembolism. An association with cerebrovascular diseases, especially cerebral venous thrombosis (CVT), has been reported among these patients. The objective of the present study was to identify risk factors for CVT as well as its presentation and outcome in COVID-19 patients. Methods: This is a multicenter and multinational observational study. Ten centers in 4 countries (Pakistan, Egypt, Singapore, and the United Arab Emirates) participated in this study. The study included patients (aged >18 years) with symptomatic CVT and recent COVID-19 infection. Results: Twenty patients (70% men) were included. Their mean age was 42.4 years, with a male-to-female ratio of 2.3:1. Headache (85%) and seizures (65%) were the common presenting symptoms, with a mean admission Glasgow Coma Scale (GCS) score of 13. CVT was the presenting feature in 13 cases (65%), while 7 patients (35%) developed CVT while being treated for COVID-19 infection. Respiratory symptoms were absent in 45% of the patients. The most common imaging finding was infarction (65%), followed by hemorrhage (20%). The superior sagittal sinus (65%) was the most common site of thrombosis. Acute inflammatory markers were raised, including elevated serum D-dimer (87.5%), erythrocyte sedimentation rate (69%), and C-reactive protein (47%) levels. Homocysteine was elevated in half of the tested cases. The mortality rate was 20% (4 patients). A good functional outcome was seen in the surviving patients, with a mean modified Rankin Scale score at discharge of 1.3. Nine patients (45%) had a modified Rankin Scale score of 0–1 at discharge. Conclusion: COVID-19-related CVT is more common among males at older ages when compared to previously reported non-COVID-19-related CVT cases. CVT should be suspected in COVID-19 patients presenting with headache or seizures. Mortality is high, but functional neurological outcome is good among survivors.

Background: Epilepsy is a persistent tendency to experience epileptic seizures and can lead to various neurobiological disorders, with an elevated risk of premature mortality. This study evaluates the efficacy of brivaracetam adjuvant therapy in patients with epilepsy. Methods: A prospective observational multicentre study that was conducted in Pakistan from March to September 2022, by using a non-probability convenience sampling technique. The population consisted of 543 individuals with a diagnosis of epilepsy for whom adjunctive brivaracetam (Brivera; manufactured by Helix Pharma Pvt Ltd., Sindh, Pakistan) was recommended by the treating physician. The research sample was drawn from various private neurology clinics of Karachi, Lahore, Rawalpindi, Islamabad and Peshawar. Data originating from routine patient visits, and assessments at three study time points, were recorded in the study case report form. Results: Across four clinical sites, 543 individuals participated, with a mean age of 32.9 years. The most prescribed dosages were 50 mg BD, followed by 100 mg BD. Notably, brivaracetam combined with divalproex sodium was the most prevalent treatment, followed by brivaracetam with levetiracetam. At both the 14th and 90th day assessments, a significant reduction in seizure frequency was observed, with 63.1% of individuals showing a favourable response by day 90. Treatment-naive individuals exhibited higher rates of seizure freedom and response compared with treatment-resistant individuals. Conclusions: The study demonstrates the effectiveness of brivaracetam combination therapy in epilepsy management, with notable reductions in seizure frequency and favourable clinical responses observed, particularly in treatment-naive individuals.

OBJECTIVE: To compare the effectiveness of Simulated Equestrian Therapy (SET) and Standard Physical Therapy (SPT) in improving gait parameters among children with Down syndrome (DS). METHODS: This single-blinded, randomized controlled trial was conducted at Dar-ul-Sukun Institute and Dr. Zaiuddin Hospital, Karachi, Pakistan, from April to August 2023. Sixty individuals, meeting the selection criteria were randomly assigned to either the treatment group (n=30) receiving SET or the control group (n=30) undergoing SPT. Nevertheless, two participants from each group either discontinued the treatment or failed to comply with the therapy and 56 participants (n=28 in each group) were included for analysis. Safety measures included recording blood pressure and heart rate before and after each session. Temporal gait parameters were assessed using the 10-Meter Walk Test at baseline, 6 weeks, and 12 weeks. Data was analyzed using Medcalc software. RESULTS: Temporal gait parameters were analyzed for 56 (33 males and 23 females) children with DS in both groups. Mean age of patients in SET & SPT groups was 7.89±1.7 and 8.07±0.76 years respectively. Baseline showed similar scores in both groups. At 6 weeks, SET demonstrated significant improvement in cadence (1.78 SPM to 1.35) and gait velocity (2.11 MPS to 2.79), paralleled by SPT (cadence: 2.01 to 1.32 SPM, gait velocity: 2.12 to 2.83 MPS). Between-group analysis revealed no significant differences. CONCLUSION: Both SET & SPT effectively improve gait parameters in children with Down syndrome. The comparable outcomes highlight SET as a viable alternative, providing clinicians and caregivers additional options for personalized therapeutic approaches.

OBJECTIVE: to assess the incidence of hyperammonemia in patients receiving valproic acid (VPA) therapy. METHODS: This cross-sectional study was conducted at the Department of Neurology, Ziauddin Medical University and Hospital, Karachi, for six months from April to October 2019. A total of 158 patients of both genders, aged between 18 to 80 years, presented in emergency with complaints of seizures and who had received a minimum dose of valproic acid before blood withdrawal were included. Pregnant women, patients with cirrhotic liver, or chronic renal impairment were excluded from the study. RESULTS: Out of 158 patients, 80 (50.6%) were females and 78 (49.4%) were males. Mean age of patients was 55.53±18.26 years. Among the participants, 27 (17.1%) had undergone VPA therapy for 30 days or more, while 131 (82.9%) had received it for less than 30 days. The mean duration of VPA therapy was 8.58±10.41 days. Among the 158 patients, 95 (60.1%) with seizures receiving VPA treatment were diagnosed with hyperammonemia. The mean serum ammonia level was 66.50±44.59 mg/dL, and mean VPA dose administered was 1000±125 mg/day. There was a statistically significant association between the dose of Valproic Acid and the incidence of hyperammonemia (p