Pakistan Journal of Neurological Sciences

Anatomical localization in the age of investigations: the skill that still defines a neurologist

Wajid Jawaid — 2026-08-08

Brain death and end-of-life decision making: an Islamic perspective

Safa Younis — 2026-09-09

Seizure spectrum in children with subacute sclerosing panencephalitis: a cross-sectional study from a tertiary care center

Naveed Anjum — 2026-08-08

Background and Objective:

Subacute sclerosing panencephalitis (SSPE) is a progressive and fatal neurodegenerative disorder caused by persistent infection of the central nervous system with a mutated measles virus. The objective of this study was to describe the spectrum and electroclinical characteristics of seizure types in children with SSPE.

Methods:

This retrospective observational study was conducted at a tertiary-care pediatric neurology center in Pakistan from January 2020 to December 2025. Children aged 2–14 years fulfilling modified Dyken’s criteria for SSPE were included. Clinical records, electroencephalography (EEG), and laboratory data were reviewed. Seizure semiology and electroclinical features were analyzed, and seizures were classified according to the International League Against Epilepsy 2017 criteria.

Results:

A total of 125 children were analyzed (male: female ratio 3:1; mean age 7.1 ± 2.8 years). Myoclonic seizures were most frequent (52.8%), followed by movement disorder–associated paroxysmal events in the form of dystonia (21.6%), generalized tonic–clonic seizures (13.6%), atonic seizures (5.6%), and focal seizures (4.0%). EEG showed no focal or lateralized epileptiform activity; rather, all patients exhibited generalized periodic high-amplitude slow-wave complexes, frequently time-locked with myoclonic jerks. Seizures were frequent and pharmacoresistant, with sustained seizure control achieved in only 6.4% of patients. Severe postictal impairment was observed in 65.6% of cases.

Conclusion:

Children with SSPE exhibit a distinctive epileptic phenotype dominated by myoclonic and dystonic posturing with characteristic EEG correlates. Early recognition of these patterns aids diagnosis, while effective measles immunization remains the only proven preventive strategy.

Frequency of diabetes mellitus in patients diagnosed with carpal tunnel syndrome: a study from a tertiary care setting

Harwindar Kumar — 2026-08-08

Background and Objective:

Carpal tunnel syndrome is a common entrapment neuropathy caused by compression of the median nerve when it passes through the wrist. The objective of this study was to determine the prevalence of diabetes mellitus in patients diagnosed with carpal tunnel syndrome.

Methods:

This descriptive cross-sectional study was conducted at the neurology unit of Lady Reading Hospital, Peshawar, from December 2019 to June 2020. A total of 140 patients aged 20–60 years with electrophysiologically confirmed carpal tunnel syndrome were included using non-probability consecutive sampling. Diabetes mellitus was established based on prior diagnosis, use of antidiabetic medications, or laboratory criteria as per American diabetes association. Data was analyzed using SPSS version 23.

Results:

Out of 140 patients, 91 (65.0%) were male and 49 (35.0%) were female. Most patients were aged 41 to 50 (42.9%). Diabetes mellitus was present in 24 patients, yielding a prevalence of 17.1% (95% CI: 10.9–23.3%). A significant association was seen between diabetes mellitus and age (χ² = 53.34, p < 0.001) and gender (χ² = 15.597, p < 0.001).

Conclusion: Diabetes mellitus was present in 24 (17.1%) of patients with CTS. Despite the limitations of cross-sectional design which precludes the establishment of causal relationships, our findings support consideration for routine metabolic screening in patients particularly in regions with a high burden of diabetes.

Frequency of carpal tunnel syndrome among hospital workers using ultrasonography: a cross-sectional study

Shakeela Ghazala — 2026-08-08

Background and Objective:

Non-invasive ultrasound imaging has emerged as a robust diagnostic tool to examine the median nerve and identify early signs of carpal tunnel syndrome (CTS), contributing to the early detection and management. The objective of this study was to determine the frequency of CTS among hospital workers using ultrasonography technique.

Methods:

This was a cross-sectional conducted at Department of neurology, Federal Government Polyclinic Hospital, from September 7, 2023 to March 6, 2024. All eligible individuals meeting inclusion criteria, were enrolled after obtaining informed consent. Following clinical examination, participants were referred to the radiology department for CTS diagnosis using ultrasound technique. Data was analysed by IBM SPSS (version 27.0).

Results:

There were 260 healthcare staff enrolled in this study. The mean age was 36.8±15.3 years. There were 96 (36.9%) males, while 164 (63.1%) were female. The prevalence of CTS was found to be 22.3%, where significant association was found between occurrence of CTS and gender (p<0.01) and employment status (p=0.017).

Conclusion:

CTS is commonly prevalent in hospital workers who have numbness and pain in fingers. This disease condition was more frequently found among males and physicians healthcare cadre.

Patterns of central nervous system infections in Pakistan: a cross-sectional multicenter study

Zainab Memon — 2026-04-15

Background and Objective:

In low- and middle-income countries, central nervous system infections are amongst the neurological entities associated with significant disability. Despite the availability of both preventative and antimicrobial treatment, management of CNS infections continues to be a great challenge. The objective of this study was to assess the pattern of CNS infections across multiple urban and rural centers in Pakistan.

Methods:

A cross-sectional observational study was conducted across 39 outpatient neurology centers in Pakistan, including both public and private setups from August 2017 to December 2019. Data on demographics, comorbidities, and categorization of CNS infections were obtained from the hospital records. Disability as a measure of outcome was classified using the Modified Rankin Scale (mRS). SPSS 25.0 was used for statistical analysis of the data.

Results:

A total of 455 patients with CNS infections were analyzed. Tuberculous meningitis (38%) was the most prevalent, followed by bacterial meningitis (27.9%) and viral meningitis (22.9%). Fungal infections (2.9%), brain abscesses (2.4%), and rare cases of amoebic encephalomyelitis (0.4%) were also observed. The mean age was 38.8 years, with 40.2% of cases occurring in young adults (18–30 years). Males (53.4%) were slightly more affected than females. Hypertension (16.3%) and diabetes (10.1%) were the most common comorbidities. Post-infection disability was seen in 15.7% of cases, with 4.6% being bedridden.

Conclusion:

The findings indicate that tuberculosis meningitis and bacterial meningitis constitute the majority of CNS infections. Early diagnosis, improved vaccination coverage, and better antimicrobial stewardship play a key role in long-term outcomes

Unveiling gender disparities in cerebrovascular accident outcomes: a retrospective analysis

Anjali Shankar — 2026-09-09

Background and objective:
Cerebrovascular accidents cause significant global mortality and disability. Sex-specific disparities in presentation and recovery may affect prognosis, especially in resource-limited settings like Pakistan. The objective of this study was to investigate gender-based differences in clinical profiles, comorbidities, and short-term outcomes of acute stroke patients in a tertiary care centre in Larkana, Pakistan.

Methods:
A retrospective observational study was conducted on 194 patients diagnosed with acute ischemic stroke confirmed through CT or MRI scan. Among them, 110 (56.7%) were females and 84 (43.2%) were males, with an overall mean age of 41.5 ± 5 years (range 18–65 years). Data on demographics, comorbidities, stroke severity (NIHSS), and functional outcomes (mRS) were analyzed using SPSS version 21. Quantitative data were expressed as mean ± SD, while categorical variables were presented as percentages. A p-value <0.05 was considered statistically significant.

Results:
Hypertension (26.8% females vs. 30.9% males) and diabetes mellitus (22.1% females vs. 7.7% males) were the most common comorbidities. Severe stroke (NIHSS >16) was observed in 40.9% of women compared to 11.9% of men, while mild stroke (NIHSS <8) was seen in 27.2% of females and 23.8% of males. At discharge, 50% of men achieved functional independence (mRS 0–2) versus 22.7% of women. In-hospital mortality was higher among females (7.27%) than males (4.7%), and 34.5% of women had prolonged hospitalization (>7 days).

Conclusion:
The study identified significant gender-based differences in stroke presentation and outcomes, with women exhibiting greater disease severity and higher mortality.

Mechanistic architecture of emerging neurotherapeutics - natural bioactive and synthetic drugs as multi-target modulators: a narrative review

Priya Tufail — 2026-08-08

Background and objective:
Neurodegenerative disorders (NDs) represent a major global healthcare challenge, affecting millions of individuals worldwide. These disorders are characterized by progressive deterioration of cognitive and motor functions. Current therapeutic strategies offer only limited disease modification, highlighting the urgent need for more effective treatment approaches. In recent years, increasing attention has been directed toward both natural and synthetic compounds as potential preventive and therapeutic agents for NDs. The objective of this narrative review was to investigate and summarize the neuroprotective and anti-inflammatory potential of natural and synthetic compounds in the prevention and management of NDs.

Methods:
A comprehensive review of existing literature was conducted focusing on the neuroprotective, antioxidant, and
anti-inflammatory effects of natural molecules such as polyphenols, flavonoids, and omega-3 fatty acids, as well as synthetic compounds including antioxidants, anti-inflammatory agents, cholinesterase inhibitors, dopamine agonists, and NMDA receptor antagonists.

Review:
Natural compounds demonstrate significant antioxidant and anti-inflammatory properties, disrupt pathological protein aggregation, regulate intracellular signaling pathways, and enhance neuronal resilience. Synthetic agents have shown benefits in improving cognitive function, modulating neurotransmitter activity, and enhancing patients’ quality of life.

Conclusion:
Natural and synthetic compounds provide valuable therapeutic prospects for the management of NDs. However, large-scale and rigorously designed clinical trials are essential to establish their long-term safety, efficacy, and clinical applicability.

Bilateral paramedian thalamic infarction presenting with atypical pseudobulbar effect: a diagnostic challenge

Tahira Siddiqui — 2026-11-04

Bilateral thalamic infarction is a rare subtype of ischemic stroke often resulting from occlusion of artery of Percheron (AOP), diagnosed after excluding alternative arterial, venous & non-vascular etiologies. Altered sensorium and abnormalities in eye movements are common manifestations. We present the case of a 31-year-old woman attending our tertiary care hospital with presentation of sudden onset altered mentation associated with pseudobulbar affect and dysarthria. Her neuroimaging exhibited bi-thalamic infarcts. The clinical diagnosis of this entity remains challenging, particularly when classical symptoms are lacking.

Long-term follow-up of a child with hypermanganesemia with dystonia, polycythemia and cirrhosis

Jay Kumari — 2026-08-08

Hypermanganesemia with dystonia, polycythemia and cirrhosis (HMDPC) is a rare but treatable inherited metal deposition syndrome, which occurs due to mutation in SLC30A10 gene. This leads to increase in manganese (Mn) levels in the blood and its deposition in the brain, muscles and liver which results in extrapyramidal symptoms, polycythemia and/or liver cirrhosis. This case report describes a five-year follow-up of a child with HMDPC treated with ethylenediaminetetraacetic acid (EDTA) as chelation therapy. This case also highlights the importance of early recognition and initiation of treatment for children with HMDPC and emphasizes the need for screening of siblings for early detection. The use of EDTA as chelation showed significant improvement of symptoms in this case, however, literature is yet to report the best treatment option for HMDPC. There is a need for more such case reports to help assess the gold standard of management of HMDPC cases.