Pakistan Journal of Neurological Sciences

Neurology residency training in Pakistan: current status and future

2026-07-17T06:32:51+00:00

Spectrum of headache disorders in Pakistan: a multicenter study

2026-07-17T06:30:26+00:00

Background and Objective:

Headache disorders represent some of the most prevalent neurological conditions worldwide. While community-based studies provide general prevalence, data on their diagnostic spectrum in specialized clinical settings in Pakistan remain limited. The objective of this multicenter study was to evaluate the demographic distribution and spectrum of headache disorders among patients presenting to neurological services across Pakistan.

Methods:

This cross-sectional observational study was carried out at 39 neurology centers across Pakistan, from August 2017 to December 2019. Diagnosis was made using International Classification of Headache Disorders, 3rd edition (ICHD-3). Demographic details, and headache subtypes were compared across gender and age. Chi-square analysis was used, with p < 0.05 considered significant.

Results:

Among the 5,366 patients, 1,903 (35.4%) were male and 3,463 (64.6%) were female. The most frequent age group was 18-30 years. Migraine was the predominant diagnosis (57.4%), with a significantly higher prevalence in females than males (60.8% vs 51.2%; p < 0.001). Tension-type headache (30.2%) and cranial neuralgias (4.8%) both increased with age. Other headache disorders included cluster headache (1.7%), and headaches attributed to psychiatric (1.2%) and vascular disorders (1.0%), along with other secondary causes, which were less frequent overall and showed heterogeneous age and gender distributions across subtypes.

Conclusion:

This regional dataset highlights migraine as the most prevalent headache disorder, especially in younger adults and females, while tension-type headache and cranial neuralgias are more frequent in older patients. These findings emphasize important demographic variations in headache patterns in tertiary care settings in Pakistan.

Electrophysiological localization and prognostic indicators in radial neuropathy presenting as wrist drop: a three-year retrospective observational study

2026-07-17T06:28:58+00:00

Background and Objective:
Radial neuropathy is a common cause of wrist drop, and accurate lesion localization is essential for appropriate
management and prognostication. The objective of this study was to analyze electrophysiological localization patterns of radial nerve lesions presenting as wrist drop and to assess whether earlier referral for electrophysiological evaluation was associated with recovery outcomes.
Methods:
This retrospective observational study was conducted at Lady Reading Hospital Peshawar, a tertiary care setting, over a three-year period (January 2022–December 2024). Adult patients with wrist drop and electrophysiological confirmed radial neuropathy were included. Nerve conduction studies and needle electromyography were used to classify lesions as high radial nerve palsy, posterior interosseous nerve (PIN) syndrome, or radial tunnel syndrome. Functional recovery at ≥3 months was categorized as complete, partial, or none. Outcomes were compared between early (≤4 weeks) and delayed (>4 weeks) electrophysiological evaluation. Data was analyze using SPSS version 25.0.

Results:
Fifty-four patients were analyzed (mean age 42.3 ± 15.2 years; 70.4% male). High radial nerve palsy was the most common lesion (61.1%), followed by PIN syndrome (29.6%) and radial tunnel syndrome (9.3%). Compression was the leading etiology. Complete recovery was significantly more frequent in patients undergoing early electrophysiological evaluation compared with delayed assessment (76.0% vs. 44.8%; p = 0.03).
Conclusion:
Early EMG testing itself does not directly improve nerve recovery. Instead, earlier electrophysiological referral may facilitate timely diagnosis and management, which could contribute to improved functional outcomes.

Visual and brainstem evoked potentials: a retrospective cross-sectional audit from a tertiary care hospital in Pakistan

2026-07-17T06:30:12+00:00

Background and Objective:

Visual and brainstem auditory evoked potentials (VEPs and BAEPs) are standard techniques for evaluating the integrity of visual and auditory pathways respectively. The objective of our audit study was to assess demographic trends, referral indications, and electrophysiological outcomes of patients undergoing VEP and BAEP testing in a tertiary care neurophysiology laboratory in Pakistan.
Methods:

A retrospective, cross-sectional audit was conducted of 952 patient records (VEP, n=219; BAEP, n=733) over a three-year period from neurophysiology laboratory of Aga Khan University Hospital. Demographic characteristics, clinical referral indications, and electrophysiological findings were collected. Standard ACNS guidelines were used for all recordings. Statistical analysis was descriptive, with categorical variables expressed as frequencies and percentages.
Results:

In the VEP cohort (51.1% female; 48.9% male), the 1-10-year age group underwent a VEP most commonly. The predominant referral indication was visual loss with optic neuropathy (52.5%), and bilateral optic pathway dysfunction (42.3%) was the most frequently seen abnormality. The BAEP cohort was also predominantly in the 1-10-year age group. Primary referral indications were delayed speech development (42.7%) and hearing loss (26.6%); peripheral auditory pathway dysfunction (53.2%) was the most common abnormal finding.
Conclusion:

Our study demonstrates the primary utility of VEPs and BAEPs in evaluating pediatric and young adult populations for optic neuropathy and peripheral auditory dysfunction, respectively. These data underscore the critical role of evoked potential testing in the early diagnosis and management of visual and auditory pathway disorders, supporting its integration into standard diagnostic protocols.

Alarming rate of hemorrhagic stroke showing an urgent need for hypertension control: a retrospective study from a major stroke center in Sindh

2026-07-17T06:29:30+00:00

Background and Objective:

Hemorrhagic stroke accounts for approximately 18–20% of the global stroke burden and is associated with high mortality and disability. It poses a significant challenge in low- and middle-income countries, where delayed presentation and inadequate risk factor control worsen outcomes. Hypertension remains the most important modifiable risk factor, particularly when poorly controlled. The objective of this study was to investigate the incidence of hemorrhagic stroke at a major stroke center and its association with uncontrolled hypertension.

Methods:

This retrospective study was conducted at Sindh institute of cardiovascular diseases (SICVD) Sukkur over three months, from May to July 2024. A total of 271 stroke patients were included. Data were analyzed to determine the distribution of stroke subtypes and the prevalence of hypertension. Statistical methods such as the chi-square test and logistic regression were used to evaluate the correlation between hypertension control and the incidence of hemorrhagic stroke.

Results:

Hemorrhagic stroke accounted for 25.7% of all stroke cases. Among patients with hemorrhagic stroke, 87.1% had uncontrolled hypertension. A statistically significant association was observed between uncontrolled hypertension and hemorrhagic stroke (p < 0.05).

Conclusion:

The incidence of hemorrhagic stroke at SICVD Sukkur was higher than global estimates and was strongly associated with poor hypertension control. These findings highlight the need for improved hypertension management strategies to reduce the burden of hemorrhagic stroke.

A retrospective analysis of relapse rates and medication compliance in bipolar I and bipolar II disorders: a comparative study

2026-07-17T06:29:16+00:00

Background and objective:
Bipolar disorder is a chronic, serious mental health condition characterized by mood episodes, and medication
non-compliance is a significant predictor of relapse. The objective of this study was to investigate the relapse rates and medication compliance in patients with bipolar I and II disorders.
Methods:
This retrospective observational study was conducted at Karwan-e-Hayat Institute for Mental Health Care, Karachi, Pakistan. Medical records of 377 patients diagnosed with bipolar I or bipolar II disorder between July 2019 and June 2022 were retrieved from the Hospital Management System (HMS). Diagnosis was confirmed using DSM-IV criteria. Medication compliance was assessed through prescription refill records, follow-up visits, and clinical documentation. Relapse was defined as any mood episode requiring hospitalization. Descriptive statistics were used to summarize data, and the Chi-square (x²) test was applied to compare groups. A p-value ≤0.05 was considered statistically significant.
Results:
Relapse rates and medication compliance were compared between the two groups using statistical analysis. Results showed that patients with bipolar I disorder had a significantly higher relapse rate (63%) compared to those with bipolar II disorder (15.2%). Additionally, medication non-compliance was more common in the bipolar I group (27.5%) than in the bipolar II group (8.2%).
Conclusion:
These findings highlight the importance of medication adherence and regular follow-up in preventing relapse,
particularly in patients with Bipolar I disorder.

Subacute sclerosing panencephalitis in a 24‑month‑old child: a rare rarly onset and alarming presentation

2026-07-17T06:32:37+00:00

Subacute sclerosing panencephalitis (SSPE) is a rare, progressive, and fatal neurodegenerative disorder caused by persistent measles virus infection. Early-onset SSPE in children under five years is uncommon but often rapidly progressive. We report a 24‑month-old unvaccinated male who presented with progressive myoclonic seizures, gait difficulty, and rapid neurodevelopmental regression. EEG showed periodic generalized discharges, and CSF measles antibody titers were elevated, fulfilling modified Dyken criteria. The child was classified as stage III SSPE. Symptomatic therapy including anti-seizure medications and supportive care, along with a planned ketogenic diet, was initiated but neurological outcome remained poor. This case emphasizes the aggressive nature of early-onset SSPE and the importance of measles vaccination.

Challenges of neurological care in a public sector hospital in Pakistan

2026-07-17T06:30:40+00:00

Lack of multidisciplinary collaboration in stroke rehabilitation in Pakistan: a call for integrated care models

2026-07-17T06:29:44+00:00

Blood- borne biomarkers: Exploring the frontiers of minimally-invasive diagnosis of Alzheimer’s disease

2026-07-17T06:29:58+00:00