Publications by authors named "Fawzi Babtain"

10 Publications

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The role of brain magnetic resonance imaging on the timing of antiepileptic drugs withdrawal following mesial temporal lobe epilepsy surgery.

Neurosciences (Riyadh) 2021 Jul;26(3):270-276

From the Department of Neurosciences (Albalawi, Babtain, Baeesa, Al- Said, Alqadi), King Faisal Specialist Hospital and Research Centre, and from the Division of Neurosurgery (Baeesa), Department of Surgery, King Abdulaziz University, Jeddah,Saudi Arabia.

Objectives: To assess the influence of magnetic resonance imaging (MRI) brain findings on the timing of antiepileptic drugs (AEDs) withdrawal following anterior temporal lobectomy (ATL) in patients with mesial temporal lobe epilepsy (MTLE).

Methods: We conducted a retrospective chart review at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia from Jan, 2004 - Dec, 2017 of patients with MTLE who underwent ATL and included patients who had a minimum of 2 years of follow-up. We evaluated the association between the time required to start tapering and discontinuing AEDs after ATL in patients with Engel class I outcomes and their preoperative brain MRI.

Results: We studied 64 patients who underwent ATL. The majority of patients (63%) had hippocampal sclerosis (HS) on histopathology. Following ATL, the mean time to start tapering AEDs was 10 months and AEDs were discontinued at a mean of 48 months. Abnormal brain MRI was observed in 53 (83%) patients, with findings suggestive of mesial temporal sclerosis (MTS) accounting for 75% of these abnormalities. The presence of any MRI abnormality was associated with a 10-month earlier tapering of AEDs (<0.01), and an 18-month earlier complete withdrawal of AEDs (<0.01). The odds of being seizure-free within the first year were higher if MTS was present in the brain MRI (adjusted OR=16). Similarly, this was associated with seizure freedom after the first year (adjusted OR=14.8, <0.01). The presence of unilateral temporal IEDs on preoperative EEG were also associated with earlier tapering and discontinuation of AEDs as well as a seizure-free state after ATL surgery (OR=8.5 and 4.2, for the first and second year respectively, <0.01).

Conclusion: Patients with abnormal MRI findings and unilateral IEDs had earlier tapering of AEDs with an overall shorter AED discontinuation plan. Moreover, the presence of MTS on MRI, along with unilateral IEDs, were predictors of seizure freedom following ATL.
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http://dx.doi.org/10.17712/nsj.2021.3.20200182DOI Listing
July 2021

Seizure outcome after epilepsy surgery for patients with normal MRI: A Single center experience.

Epilepsy Res 2021 Jul 23;173:106620. Epub 2021 Mar 23.

Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia; Neurology Section, Medical Department, Aldara Hospital and Medical Center, Riyadh, Saudi Arabia. Electronic address:

Objective: To analyze the surgical outcome in non-lesional intractable focal epilepsies in our center and to find possible predictors for better outcome.

Methods: This is a retrospective study for 40 adult patients with intractable focal epilepsy following at KFSHRC-Riyadh, who underwent presurgical evaluation followed by resective surgery and continued follow up for a minimum of 2 years. The surgery outcome was evaluated based on the type of surgical procedure and histopathology results.

Results: Out of all 40 patients studied, seizure freedom was achieved in 19 (47.5 %) and 17 (42.5 %) patients at the first and second year respectively in all non-lesional cases. Seizure freedom in non-lesional temporal lobe surgery was achieved in 10 (45 %) of patients at 2 years, 5 (38 %) in non-lesional frontal lobe patients at 2 years and 8 (44 %), 7 (38 %) for all extratemporal at 1 and 2 years respectively. Good prognosis was seen in patients with localized positron emission tomography (PET), had no aura and had a clear ictal onset either on scalp electroencephalogram (EEG) or subdural invasive electroencephalogram.

Significance: The best surgical outcome is achievable in patients with non-lesional focal epilepsy. This study highlights the prognostic value of the PET scan and ictal scalp/subdural invasive EEG.
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http://dx.doi.org/10.1016/j.eplepsyres.2021.106620DOI Listing
July 2021

Consanguinity in patients with mesial temporal lobe epilepsy due to hippocampal sclerosis in a Saudi population.

Neurosciences (Riyadh) 2020 Aug;25(4):276-280

Department of Neurosciences, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia. E-mail:

Objective: To investigate if there is an association between consanguinity and hippocampal sclerosis (HS) in the Saudi population.

Methods: A retrospective case-control study was conducted by assessing the prevalence of consanguinity in patients with pathologically proven HS, who underwent epilepsy surgery at King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia, between January 2004 and December 2015. We reviewed the medical records to extract data, which included; age, gender, duration of epilepsy, history of febrile seizure, family history of epilepsy in a first or second-degree relative, and pathology reports.

Results: A total of 120 patients, out of which 40 patients (65% male) having mesial temporal lobe epilepsy due to HS, and 80 controls (56% male) with cryptogenic epilepsy, were identified. Twenty-two patients (53.5%) in the HS group had a history of consanguinity. In the control group, 30 patients (37.5%) had a history of consanguinity. The odds ratio was 2.04 (95% confidence interval = 0.94 - 4.4, p=0.052). A family history of epilepsy was found in 28% of the patients with HS and 32.5% cryptogenic epilepsy. Only 8 patients (19.5%) with HS reported a history of febrile seizure.

Conclusion: Our retrospective case-control study suggests that consanguinity might increase the likelihood of developing HS.
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http://dx.doi.org/10.17712/nsj.2020.4.20200055DOI Listing
August 2020

The Optimal Dose of Amobarbital in the Wada Test for the Presurgical Evaluation of Patients With Temporal Lobe Epilepsy.

Clin Neuropharmacol 2020 Nov/Dec;43(6):185-190

Department of Neurosciences, King Faisal Specialist Hospital and Research Centre.

Objective: The use of amobarbital in the Wada test varied between epilepsy centers, with no unified dosing or protocols available in the literature to standardize its use. We aimed to determine the dose of amobarbital in the presurgical evaluations of patients with temporal lobe epilepsy.

Methods: A retrospective study of patients with temporal lobe epilepsy seen between January 2004 and December 2018 in King Faisal Specialist Hospital and Research Centre in Jeddah, Saudi Arabia, was conducted, and those who successfully underwent a Wada test were studied. A neuropsychologist or a neurologist will assess the memory and language, using standardized testing.

Results: A total of 90 patients were studied. The mean age was 30 years (range, 16-52 years), where 49 (57%) of them were men. All patients had a routine neurological examination, including language and memory. The average dose of amobarbital given was 10.1.1 mg (range, 65.7-150 mg). There was no statistical difference between the dosing given to patients who passed or failed the memory testing (101.4 mg vs 94.7 mg, P = 0.1). Multivariate regression analysis showed that amobarbital dose needed an adjustment to patient's weight only for those older than 30 years, (P < 0.05; 95% confidence interval, 0.1-0.5), where an increase in the dose by 0.3 mg·kg·y was required to execute Wada test successfully.

Conclusion: It was only the patient's age that could influence the modification of Amobarbital dose in the Wada test, yet establishing a universal protocol is challenging because of the lack of well-defined dose determinants.
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http://dx.doi.org/10.1097/WNF.0000000000000411DOI Listing
September 2020

Effects of fasting during Ramadan on seizure control and quality of life in patients with epilepsy.

Epilepsy Behav 2020 11 6;112:107440. Epub 2020 Sep 6.

Neurology Division, Sidra Medicine, Doha, Qatar.

Background: During Ramadan, the ninth month of the lunar Islamic calendar, adult Muslims are obliged to fast, which involves refraining from taking any food, beverages, or oral medications from dawn to sunset. Fasting's effect on seizure control is not fully understood, and a few observational studies have provided inconclusive results. This study aimed to investigate the effect of fasting during Ramadan on seizure control and quality of life in adult patients with epilepsy.

Methods: This was a prospective observational study over a 3-month period (one month before fasting, the fasting month, and one month after fasting). We recruited adult patients with active epilepsy who were able to fast during the month of Ramadan. The primary outcome measures were as follows: 1) seizure control and 2) quality of life score using the Arabic version of the Ferrans and Powers Quality of Life Index (QLI). Changes in anticonvulsant medications were not allowed during the study period. We used a seizure log provided to participants to record the number of seizures during the 3-month period. Quality of life was scored at the end of each month of the study period.

Results: Thirty-seven patients were studied (59% males). The mean age was 30 years (range, 14-51 years), and mean age at epilepsy onset was 13 years (range, 0.5-35 years). On average, patients were on three antiepileptic medications at baseline (range: 2-5). A total of 1576 seizures were reported during the 3-month follow-up, where seizures prior to fasting represented 35.5% of all seizures. Multilinear regression analysis revealed a significant decline of seizures by 21% during the fasting month compared with baseline (adjusted coefficient = 0.79, p < 0.01, 95% confidence interval (CI); 0.61-0.98, R2 = 0.81) and by 29% during post fasting compared with baseline (adjusted coefficient = 0.71, p < 0.01, 95% CI; 0.53-0.90, R2 = 0.79). No significant change was found in the QLI scores calculated during the three months of the study period.

Conclusion: Fasting during Ramadan might have a positive impact on seizure control in patients with epilepsy, which continued during the month following fasting, whereas the quality of life scores were not affected by fasting.
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http://dx.doi.org/10.1016/j.yebeh.2020.107440DOI Listing
November 2020

Impact of a family history of epilepsy on the diagnosis of epilepsy in Southern Saudi Arabia.

Authors:
Fawzi A Babtain

Seizure 2013 Sep 28;22(7):542-7. Epub 2013 Apr 28.

College of Medicine, Department of Internal Medicine, King Khalid University, Abha, Saudi Arabia.

Purpose: Epilepsy can develop at any age for reasons that remain poorly understood. The aim of this study was to determine the impact of a family history of epilepsy (FHE) on the incidence and recurrence of seizures.

Methods: This retrospective study was conducted in Aseer central hospital, Abha, Saudi Arabia between January and June 2012. The medical records of 420 patients were analyzed to test the impact of FHE on the risk factors, etiology and diagnosis of epilepsy determined by magnetic resonance imaging (MRI) and electroencephalography (EEG).

Results: 420 patients were studied. Idiopathic epilepsy was seen in 140 patients (33%), symptomatic in 152 (36%), and cryptogenic in 128 patients (30%). FHE was seen in 113 patients (27%), which was associated with younger at the disease onset (15 years vs 20 years, p<0.05). Idiopathic epilepsy was seen more in patients with FHE (43% vs 30%, p value <0.05), and generalized seizures (primary or secondary) were also seen more in patients with FHE (51% vs 36%, p value <0.05). Abnormal EEG was also seen more in patients with FHE (79% vs 66%, p<0.05). Multivariate regression analysis showed that temporal epileptic discharges were the best predictor for the presence of FHE (p<0.05, OR=3.1, 95% CI 1.7-5.8), more than idiopathic epilepsy or younger age at epilepsy onset.

Conclusions: FHE has a significant impact on epilepsy, its classifications, and the EEG findings, and may underlie the presence of a genetic etiology, which could be related to a high incidence of consanguinity seen in our population. Temporal epileptic discharges were the best predictor for FHE, which may suggest the presence of familial TLE.
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http://dx.doi.org/10.1016/j.seizure.2013.04.002DOI Listing
September 2013

Levetiracetam may worsen myoclonus in patients with juvenile myoclonic epilepsy: case reports.

Authors:
Fawzi A Babtain

Clin Neuropharmacol 2012 Jul-Aug;35(4):201-2

Neurologist, Epileptologist, Clinical Neurophysiologist, Division of Neurology,Assir Central Hospital, King Khalid University, Abha, Saudi Arabia.

Levetiracetam was approved for generalized and partial epilepsy in pediatric and adult population. It is also an effective antimyoclonus, but the evidence only supports its use as an adjunctive agent along with other antiepileptic drugs, such as sodium valproate, and it is commonly used in cases with juvenile myoclonic epilepsy. We report here 2 cases with juvenile myoclonic epilepsy who were switched from sodium valproate to levetiracetam to avoid the cosmetic or future teratogenic effect, but this switch was associated with exaggerated myoclonus despite escalating the dose of levetiracetam but resolved completely after reintroducing sodium valproate.
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http://dx.doi.org/10.1097/WNF.0b013e31825eed8cDOI Listing
May 2013

Ramsay Hunt syndrome with multiple cranial neuropathies in a liver transplant recipient.

Neurosciences (Riyadh) 2012 Jul;17(3):262-4

Department of Internal Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia.

Ramsay Hunt syndrome is an infection of the head and neck caused by varicella zoster virus involving the facial nerve; less commonly, other cranial nerves might be involved. We report a case of Ramsay Hunt syndrome in an immune compromised patient, with classic facial nerve palsy and ipsilateral ear vesicles, which rapidly evolved to involve multiple cranial neuropathies, and improved dramatically with antiviral therapy and corticosteroids. Varicella zoster virus should be considered as a cause of multiple cranial neuropathies in an immune compromised patient, and abrupt treatment with acyclovir should be initiated once this diagnosis is suspected.
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July 2012

Management of women with epilepsy. Practical issues faced when dealing with women with epilepsy.

Authors:
Fawzi A Babtain

Neurosciences (Riyadh) 2012 Apr;17(2):115-20

College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia.

Epilepsy is commonly encountered in neurology practice, affecting more than 50 million people worldwide, according to the World Health Organization reports. Management of women with epilepsy requires attention to some considerations including the hormonal changes and its impact on epilepsy, the interaction between oral contraceptives and antiepileptic drugs (AEDs), pregnancy, and the potential teratogenic risk associated with AEDs use during that period. Similarly, the effect of AEDs on bone health should always be considered, and measures should be taken to reduce the risk of osteoporosis given the fact that women in their menopause are at increased risk. Despite the considerable risk of teratogenicity with AEDs use in pregnancy, more than 90% of pregnancies will be uneventful.
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April 2012

Sporadic hemiplegic migraine with seizures and transient MRI abnormalities.

Case Rep Neurol Med 2011 25;2011:258372. Epub 2011 Sep 25.

Department of Neurology, Aseer Central Hospital, Abha, Saudi Arabia.

Hemiplegic migraines are characterised by attacks of migraine with aura accompanied by transient motor weakness. There are both familial and sporadic subtypes, which are now recognised as separate entities by the International Classification of Headache Disorders, edition II (ICHD-II). Sporadic hemiplegic migraine is a rare variant of migraine, We report a case of sporadic hemiplegic migraine and seizures with MRI features suggestive of cortical hyper intensity and edema on T2 and FLAIR images with no restriction pattern on diffusion and these changes completely resolving over time, suggesting that these changes are due prolonged neuronal depolarization and not of ischemic origin.
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http://dx.doi.org/10.1155/2011/258372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3420796PMC
August 2012