International Clinical Neuroscience Journal

Background: Poor sleep quality and sleep deprivation provoke epileptic seizures, and sleep-related epilepsy and antiseizure medications (ASMs) affect sleep quality. There is still a limited study exploring the relationship between ASM consumption and the sleep quality of epilepsy patients in developing countries, and this study will be the first one conducted in Indonesia.

Methods: This cross-sectional study was conducted from April to June 2023. Subjects were patients aged 18-65 years old, electro-clinically diagnosed with any epilepsy, who had taken at least one ASM. They were seizure-free for at least three months, without a history of anxiety, depression, poor sleep hygiene, or medication adherence. Sleep quality is measured using the Pittsburgh Sleep Quality Index (PSQI). The Fisher-exact test is used to analyze the association. A p-value of <0.05 is considered statistically significant.

Results: A total of 64 subjects were included, consisting of 33 males (51.6%), with a median age of 37.8 ± 13.8 years. Poor sleep quality was found in 24 subjects (37.5%) with a median PSQI score of 4.8. Older-generation ASMs (p = 0.023), polytherapy (p = 0.02), and ASM use for less than 1 year (p = 0.003) were significantly associated with poor sleep quality.

Conclusions: ASM type, consumption duration, and the number of ASMs are significantly associated with sleep quality. Therefore, routine evaluation of sleep quality and appropriate ASM is recommended for epilepsy patients.

Conclusion: The study will be useful while performing surgical procedures around the axis vertebrae to prevent injury to vital structures.

Background: This study aimed to investigate the qualitative effects of semantic anomalies on event-related potentials (ERPs) in the context of Persian language processing. Comprehending sentences and integrating words in the correct order are crucial aspects of language processing. Understanding how the brain accomplishes this task during reading, writing, and listening is of great importance.

Methods: In this experiment, 10 healthy, right-handed, Persian-speaking participants (10 women, 10 men) aged 18-40 were included. Four types of sentences, including control conditions and semantic anomalies, were presented word-by-word on a monitor while EEG was recorded with a 64-channel system. The collected signals were analyzed, and the ERPs components were compared statistically.

Results: The presence of a semantic irregularity, specifically an incoherent verb at the end of a sentence, leads to the activation of the N400 component. This component is associated with symmetrical electrode distribution across the anterior, central, and parietal regions of the scalp. On the other hand, when the semantic irregularity in the form of an incoherent verb is positioned in the middle of the sentence, it elicits the production of the P600 component. The corresponding electrodes associated with the P600 component exhibit a distribution that is central, parietal, and left anterior.

Conclusion: The findings contribute to our understanding of the relationships between semantic processing and the N400 component, as well as between syntactic processing and the P600 component. The absence of N400 in the presence of semantic irregularities and the presence of P600 in the absence of semantic anomalies align with the dynamics of the language processing system, where distinct processing units interact and communicate independently.

 Background: Acute ischemic stroke is a sudden disruption in blood flow to the brain, leading to neuronal damage that occurs secondary to inflammation. The outcome depends on the type of stroke, the duration of treatment, and the patient's physical status. Lymphocyte-to-monocyte ratio (LMR) is an emerging biomarker that can predict stroke severity and functional outcome in AIS patients.

Methods: This was a prospective, observational study including cases of ischemic stroke presenting to a tertiary care center in Kerala. Patients with neurological symptoms were evaluated according to the NIHSS score, and blood samples were sent for analysis. Patients who presented to the emergency department from July 2024 to December 2024 were included in the study, and a total of 126 patients were observed

Results: This study shows that the NIHSS score used to grade stroke severity at admission was negatively associated with LMR values. This shows that lower LMR values are associated with greater stroke severity. A cutoff value of 2.9 was used for this study, and it showed high accuracy. The result of the Spearman correlation showed that there was a very high, negative correlation between LMR and NIHSS Score. The results showed that this correlation between LMR and NIHSS Score was a statistically significant negative correlation, r(124) = -0.71, p = <.001.

Conclusion: LMR can be used as an important and effective biomarker in evaluating the severity of the disease and in predicting the outcome in patients with acute ischemic stroke.

Background: The axis is the second cervical vertebra and is special in having the upward bony projection from its body called the dens. It functions as the pivot around which the first cervical vertebra rotates.

Methods: The present study was observational and conducted in the Department of Anatomy, Government Medical College, Srinagar. The linear and angular parameters were recorded using a manual vernier calliper and goniometer. The vernier calliper's depth gauge was used to measure the depth of the foramen transversarium. All the identical structures were measured on both sides. The measurements recorded from each vertebra on each axis were analyzed statistically using SPSS Statistics.

Results: All the linear paired and unpaired parameters have been recorded using a manual vernier calliper and goniometer. The body's mean A-P diameter was 15.3±1.76mm, and the transverse diameter was 18.56±1.85mm. The anterior body height was measured at 22.3±1.75mm, and the posterior body height was 17.2±1.55mm. Similarly, the mean height of dens was 15.8±1.77mm, the A-P diameter was 10.7±0.99mm, the maximum width was 10.3mm, and the minimum width was 8.51±0.01 mm. The total height of the dens was 38.1±2.57 mm. Similarly, the dimensions of the pedicle, lateral mass, superior articular facet, inferior articular facet, foramen transversarium, and vertebral foramen were also measured and compared with previous studies.

Conclusion: The study will be useful while performing surgical procedures around the axis vertebrae to prevent injury to vital structures.

Alzheimer’s Disease (AD), a leading cause of dementia, affects over 50 million people worldwide and is characterized by progressive cognitive decline, memory impairment, and behavioral changes. Early and accurate diagnosis remains critical for effective intervention, yet traditional methods often face challenges in scalability and precision. In this mini review, we evaluate the emerging role of Swarm Intelligence (SI) in the diagnosis of AD using Electroencephalography (EEG) and Magnetic Resonance Imaging (MRI) modalities. While traditional diagnostic methods suffer from limitations, SI-based algorithms, inspired by the collective behavior of biological swarms, are well-suited to manage complex datasets. Feature selection, parameter tuning, and pattern recognition benefit from techniques such as Particle Swarm Optimization (PSO), Ant Colony Optimization (ACO), and Bee Colony Algorithm (BCA). This review highlights SI’s computational efficiency, robustness, and transformative potential in improving diagnostic accuracy and scalability. We also address future challenges and research directions essential for integrating SI into real-world AD diagnostic systems. Ultimately, this work underscores SI’s promise in revolutionizing AD detection and enhancing patient outcomes.

Cognitive decline and progressive neuropathy due to Alzheimer's disease (AD) are on the rise throughout the world today. By impairing function and reducing the affected person's quality of life, it worsens the global burden of the disease. Many treatment options are available; however, it is important to note that each has its pros and cons and should be compared side by side to develop an individualized therapeutic approach. While a few new advanced therapeutic discoveries gain traction, such as the use of polyethylene glycol (PEG)-modified black phosphorus nanosheets (BP-PEG) and revolutionary gene editing using CRISPR/Cas9, there is a need for more data available from clinical trials for a better understanding of the new techniques being worked on. Some advancements, although promising, have yet to progress from animal models to human clinical trials. A call for further investigation appears to be necessary to weigh the advantages and disadvantages of both pharmacological and non-pharmacological therapy for AD.

Background: The Pterygospinous and the Pterygoalar foramina are rare anatomical structures on the skull's base near the sphenoid bone. These structures have clinical significance as landmarks in medical and surgical procedures. Understanding the anatomy and incidence of ossified ligaments associated with these foramina is crucial for neurosurgical, dental, and maxillofacial procedures. The present study was undertaken to assess the incidence, structural details and clinical importance of formation of unusual foramina of sphenoid bone in the skulls of Indian population.

Methods: The present observational study was conducted on 200 dry skulls and disconnected sphenoid bones. Direct cranioscopy and digital caliper measurements were used to assess the pterygospinous and pterygoalar foramina, ossification, and location of ligaments. The observed data were statistically analyzed using SPSS 22 software.

Results: Complete ossification of the pterygospinous foramen was observed bilaterally in 1% of bones, with incomplete ossification in 5.5% of bones. In the pterygoalar foramen, complete ossification was found in 2% of cases on the left and 1% on the right sides. Incomplete ossification was observed in 1% on the left side, 2.5% on the right side, and 1.5% bilaterally. The measurements of both foramina indicated that the Pterygospinous foramen had a larger diameter than the Pterygoalar foramen.

Conclusion: The incidence of ossified pterygospinous and pterygoalar ligaments and their foramina formation in the skulls of the Indian population is low. Understanding the prevalence and anatomy of these structures is crucial for medical professionals to diagnose and treat neurological and maxillofacial conditions.

Ulnar neuropathy at the wrist is uncommon and can be caused by various extrinsic and intrinsic factors. Prolonged pressure on a bicycle handlebar can cause symptoms of distal ulnar palsy, known as cyclist's palsy. It can present with purely sensory, purely motor, or combined sensorimotor symptoms and is a challenging clinical diagnosis. Our patient presented with acute right-hand grip weakness and tingling in both hands after a bike ride. A prompt and detailed nerve conduction study (NCS) and needle electromyography (EMG) diagnosed right ulnar neuropathy in Guyon's canal, affecting only its deep motor branch, distal to the hypothenar branch. Stimulation in the palm showed a conduction block in these fibres, thus establishing a neuropraxic neuropathy. In addition, there was evidence of bilateral Carpal Tunnel Syndrome. The patient recovered completely with conservative management. This case illustrates the use of NCS/EMG to diagnose an uncommon neuropathy, resulting in optimal patient outcomes.

Parenteral diarrhea due to infections outside the gastrointestinal tract is a well-known entity in pediatrics. We report a case where a child with invasive pneumococcal infection presented with parenteral diarrhea and later CSF rhinorrhea, revealing the underlying inner ear malformation. A 15-month-old male child with isolated language delay due to congenital hearing loss presented with pneumococcal septic shock following acute gastroenteritis. Two days later, CSF rhinorrhoea was noted. The Child was stabilised with intravenous fluids and antibiotic therapy. Computed tomography imaging revealed a congenital bony inner ear malformation (IEM). Recurrent meningitis can occur due to communication between IEM and the subarachnoid space. CSF otorrhoea presenting as rhinorrhoea can occur due to meningitis with raised intracranial pressure. Children presenting with invasive pneumococcal infection and sensorineural hearing loss should be evaluated for predisposing factors, such as cerebrospinal fluid leaks, which can unmask underlying inner ear abnormality.

Brainstem encephalitis (BE) is a rare disease that affects 1 in 10,000 individuals each year. However, quite little is known about the aetiologies causing brainstem encephalitis. Scleroderma is a rare connective tissue disorder with pathophysiology still under research. We hereby report a case of systemic sclerosis that primarily presented with brainstem encephalitis, a relatively uncommon presentation, and was retrogradely evaluated, assessed, and diagnosed as diffuse systemic sclerosis (Ds-SSc).

Systemic sclerosis is associated with multisystem involvement (multiple internal organs simultaneously or sequentially) and is associated with increased morbidity and mortality, with uncommon involvement of the brainstem. Hence, in any case of brainstem encephalitis in a young patient with no apparent infectious cause, an elaborate examination of all systems and autoimmune profiles must be performed to enable rapid initiation of treatment and, therefore, improve prognosis.