Eating Epilepsy in Oman : A case series and report on the efficacy of temporal lobectomy

Eating epilepsy (EE), where seizures are triggered by eating, is rare and has not been reported in the Gulf region. In EE, the ictal semiology includes partial or generalised seizures. Focal brain changes on imaging, if present, are often confined to the temporal lobe or perisylvian region. Therapeutic options, especially in those patients who are refractory to pharmacotherapy, have not been well-established. We report a series of five patients with EE from Oman, a country located in the eastern part of the Arabian Gulf region, and highlight the usefulness of temporal lobectomy in one patient who had medically-intractable EE. Surgical intervention could be considered as a potential therapeutic option in carefully selected patients with medically-intractable seizures

Clinical and Autoimmune Profiles of Omani Patients with True Versus False Positive Autoimmune Encephalitis Antibodies Panels

The incidence of autoimmune encephalitis (AE) is rising due to increased awareness of the condition and detection of new autoantibodies. Coinciding with this rise are false positive autoantibodies without clinical correlates. Objective: To explore the clinical profiles of Omani patients who are truly positive for AE autoantibodies and compare them with those with false-positive autoantibodies. Methods: We reviewed the medical records of all patients who tested positive for AE antibody from May 2016 to December 2022. Cases were verified by three neurologists based on the existing criteria for AE. Results: The participants comprised N = 67 patients, 19 (28%) of whom fulfilled the criteria for AE. True-positive AE patients were younger with mean age of 35.3 ± 4.7 years (p = 0.010). They were also more likely to present with subacute memory disturbances (6/19; 32%; p = 0.030), seizures (12; 63%; p = 0.028), abnormal electroencephalogram (EEG) findings (10; 65%; p = 0.040), and abnormal signals in limbic region on magnetic resonance imaging (MRI) (5; 26%; p = 0.010). Subacute memory disturbance was a significant predictor for true positivity (OR = 17.807, 95%CI = 1.608–197.202; p = 0.019). Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis was the most frequent type of AE (8; 42.1%), followed by anti-glutamic acid decarboxylase 65 (GAD65) (4; 21.1%). Conclusion: Of the 67 cases with positive AE autoantibody panel, 48 (72%) were false-positive. The presence of subacute memory impairment was a significant predictor of AE. Anti-NMDAR encephalitis was the most frequent AE encountered in our cohort

Medical Tourism and Neurological Diseases: Omani Patients’ Experience Seeking Treatment Abroad

Objectives: There is a dearth of research regarding the motivations and experiences of Omani nationals who travel abroad for medical treatment, especially for neurological diseases. The primary objective was to examine and draw comparisons between Omani adults and children with neurological disorders who pursued medical treatment abroad after being evaluated by local specialists. The study also aimed to gain insights into these patients’ motivations and experiences. A related objective was to explore the sociocultural factors and family dynamics that shape the attitudes towards illness and treatment seeking. Methods: In this cross-sectional study, Omani patients treated at a major tertiary hospital in Muscat for neurological disorders and subsequently traveled overseas for treatment were identified and administered a structured questionnaire. Results: The participants were 116 Omani nationals (62 children and 54 adults) with neurological disorders, diagnosed predominantly with epilepsy (71.6%) followed by developmental delay, muscular dystrophy, and encephalopathy. Only 19.8% of patients received government sponsorship. The majority (69.8%) followed the recommendations of family members. Most (63.8%) participants reported positive outcomes after treatment abroad, though 4.3% developed complications and 5.2% acquired nosocomial infections. Most (83.6%) participants opined that the treatment they received overseas was comparable to what they would have received in Oman. There were no significant differences between children and adults in most of these aspects. Conclusions: Public awareness should be increased regarding the pros and cons of medical tourism. Patients must be made aware of the advanced treatment facilities available locally. Efforts should be made to enhance patient outcomes and satisfaction by adopting more efficient and patient-friendly processes

Frequency of Dimethyl Fumarate Induced Lymphopaenia Among Omani Patients with Multiple Sclerosis

Objectives: Dimethyl fumarate (DMF) is known to cause lymphopenia in treated multiple sclerosis (MS) patients. There is a dearth of research on DMF therapy in the Arab world, especially in Oman. This study aimed to analyse the prevalence of lymphopenia among Omani MS patients and the reasons for discontinuing DMF. Methods: In this retrospective study, we reviewed the medical records of Omani MS patients who were treated using DMF at two tertiary hospitals in Muscat from the period 2017 February to 2023 February. Their demographic, clinical, and laboratory data were retrieved and analysed. Absolute lymphocyte count (ALC) values at baseline and at the last follow up, as well as the reasons for discontinuing DMF were collected. Descriptive and inferential statistical techniques were used for data analysis. Binary-logistic regression analysis was used to identify the risk factors for DMF-induced lymphopenia. Results: The study included a total of 64 MS patients and the majority (40; 63%) were female. The DMF therapy was started at mean age of 33 7.7 years. After administration of DMF, 14 (21.9%) patients developed 1–3 grades lymphopenia with the following breakup: grade-1: 5/64 (7.81%) patients; grade-2: 8/64 (12.5%) patients; grade-3: 1/64 (1.6%) patient. DMF was discontinued in 23 (36.0%) patients, mainly in response to adverse events or confirmed pregnancy. Female sex was the only significant predictor of DMF-induced lymphopenia (p = 0.037). Conclusion: Most Omani MS patients had mild lymphopenia (grades 1–2), like other regional and international reports. Early adverse events and pregnancy were the main reasons provided for discontinuing DMF therapy. Keywords: Multiple Sclerosis; Dimethyl Fumarate; Absolute Lymphocyte Count; Lymphopenia; Oma

Disease-Modifying Drugs and Family Planning in People with Multiple Sclerosis: A Consensus Narrative Review from the Gulf Region

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Rituximab Treatment in Myasthaenia Gravis: Report of two paediatric cases

Myasthaenia gravis (MG) is an autoimmune disease involving the postsynaptic receptors in the neuromuscular junction. The condition is characterised by fatigable weakness of the skeletal muscles and is uncommon in children. Acetylcholinesterase inhibitors and immune-modifying medications are usually considered the mainstay of treatment. However, these medications have to be given on a lifelong basis so that patients remain in remission; furthermore, drug-related side-effects can have a major impact on quality of life. We report two paediatric cases who were treated for MG at the Sultan Qaboos University Hospital, Muscat, Oman, in 2007 and 2008, respectively. Rituximab was eventually administered to each patient after their condition failed to improve despite several years of standard treatment with acetylcholinesterase inhibitors and immune-modifying medications. Overall, rituximab resulted in complete remission in one case and significant clinical improvement in the other case. Keywords: Myasthenia Gravis; Rituximab; Children; Cholinergic Receptors; Case Report; Oman

“Different Strokes”: A management dilemma

Stroke is a common medical emergency resulting from numerous pathophysiological mechanisms and with varied clinical manifestations; as such, the diagnosis of stroke requires diligent clinical assessment. When different stroke syndromes occur in the same patient, it may cause a dilemma in terms of diagnosis and management. This continuing medical education article describes an interesting patient with recurrent neurological events, highlighting the complex pathophysiological processes associated with cerebrovascular syndromes. It offers readers the opportunity to apply their own basic neuroscience knowledge and clinical skills to solve the challenges encountered during the course of diagnosing and treating this patient. Specifically, the article aims to familiarise readers with an approach to diagnosing brainstem strokes and the diverse manifestations of a common stroke syndrome. Keywords: Stroke; Lacunar Stroke; Cerebral Hemorrhage; Cerebral Small Vessel Disease; Continuing Medical Education

Spectrum of Cerebral Venous Thrombosis in Oman

Objectives: Cerebral venous thrombosis (CVT) can have varied and life-threatening manifestations. This study aimed to examine the spectrum of its clinical presentations and outcomes in a tertiary hospital in Oman. Methods: This retrospective study was conducted at the Sultan Qaboos University Hospital, Muscat, Oman, between January 2009 and December 2017. The medical records of all patients with CVT were reviewed to determine demographic characteristics, clinical features and patient outcomes. Results: A total of 30 patients had CVT. The mean age was 36.8 ± 11 years and the male-to-female ratio was 2:3. Common manifestations included headache (83%), altered sensorium (50%), seizures (43%) and hemiparesis (33%). Underlying risk factors were present in 16 patients (53%). Computed tomography or magnetic resonance imaging of the brain was abnormal in all patients, with indications of infarcts (40%) and major sinus thrombosis (100%). There were five cases (20%) of deep CVT. The patients were treated with low-molecular-weight heparin, mannitol and anticonvulsants. The majority (77%) had no residual neurological deficits at follow-up. Conclusion: These findings indicate that CVT is a relatively uncommon yet treatable disorder in Oman. A high index of suspicion, early diagnosis, prompt anticoagulation treatment and critical care may enhance favourable patient outcomes. Keywords: Venous Thrombosis; Cerebral Thrombosis; Cranial Venous Sinuses; Neurological Manifestations; Patient Outcome Assessment; Oman

Complementary and Alternative Medicine for People with Epilepsy: Opinions of Physicians in Oman

Objectives:Several studies have explored the opinions of healthcare workers on the use of complementary and alternative medicine (CAM) in epilepsy treatment. We sought to survey the views of non-neurologist and non-psychiatrist physicians in Oman on the use of CAM for epilepsy. Methods: We used convenience sampling to recruit physicians (except neurologists and psychiatrists) from all 11 governorates of Oman. The online questionnaire was open to physicians from 5 January 2022 to 15 February 2023. This study collected anonymous data on their demographics, discipline, work settings, geographical area, and years of practice. Additionally, participants were asked to answer questions about their perception of CAM use and its effectiveness in treating epilepsy. Results: A total of 190 physicians participated, of whom 69.5% were men. Respondents were mostly 36 to 45 years old (51.1%). The majority (52.1%) were general practitioners, 21.1% were internists, 17.9% were pediatricians, and 8.9% were family physicians. Most participants (n = 144; 75.8%) believed that CAM may help treat patients with epilepsy (PWE). The most common therapies that participants considered helpful were meditation (46.0%), prayers (44.7%), yoga (32.6%), and exercise (31.1%). Conclusions: While the evidence supporting the use of CAM for the treatment of epilepsy is scarce, this survey showed that most physicians (non-neurologists and non-psychiatrists), who manage PWE in Oman, believed that some CAM modalities would help treat epilepsy. Well-designed controlled trials are needed to provide reliable evidence on the usefulness of CAM options in PWE