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Program Booklet
CME ACCREDITED 14 Hr & 3rd Annual Saudi Epilepsy Meeting & 12th Annual Saudi Chapter Epilepsy Meeting 1 KING FAHAD SPECIALIST HOSPITAL - DAMMAM www.kfsh.med.sa 7th Annual Eastern Province Epilepsy Symposium KING FAHAD SPECIALIST HOSPITAL - DAMMAM 2 7th Annual Eastern Province Epilepsy Symposium 3 KING FAHAD SPECIALIST HOSPITAL - DAMMAM 7th Annual Eastern Province Epilepsy Symposium King Abdullah bin Abdulaziz Al Saud King of Saudi Arabia Custodian of the Two Holy Mosques Prince Salman bin Abdulaziz Al Saud Prince Muqrin bin Abdulaziz Crown Prince Minister of Defence of Saudi Arabia Second Deputy Prime Minister KING FAHAD SPECIALIST HOSPITAL - DAMMAM 4 7th Annual Eastern Province Epilepsy Symposium Prince Saud bin Nayef Governor of Eastern Province Jalawi bin Abdul Aziz bin Musaed Assistant Deputy Governor of Eastern Province 5 KING FAHAD SPECIALIST HOSPITAL - DAMMAM KING FAHAD SPECIALIST HOSPITAL - DAMMAM 6 7 KING FAHAD SPECIALIST HOSPITAL - DAMMAM Chairwoman Message Welcome to the Eastern Province Region, and 7th Annual Eastern Province Epilepsy symposium. We are proud to host this meeting in conjunction with 3rd Annual Saudi Epilepsy Meeting & 12th Annual Saudi Chapter of Epilepsy. Within these pages you will find the schedule of the program, exhibits, and some of the social events. It has been an exciting year, and the annual meeting brings together so much of the accomplishments of King Fahad Specialist Hospital-Dammam and our members in Neurosciences Center. We have prepared an exciting scientific program especially target on new concepts in Epilepsy. The scientific Committee this year focused on a specific subject of common interest to neurologists, epileptologists, neurosurgeons, neuropediatricians, neuropsychologists, psychiatrists, neurophysiologists and neuroscientists involved in the treatment of epilepsy. We focused on mesial temporal lobe epilepsies because this is the group of focal epilepsy syndromes (or» constellations» according to the newly proposed ILAE terminology) which is most prevalent, most frequently operated and has therefore been at the center of interest of epileptologists and neuroscience for long time. Major progress in the understanding of MTLE has been made. These advances include our understanding of the classification of MTLE, its correlation with the clinical course as well as the ability to model this disease in toxins-free animal models and to investigate and further define it through genetic, immunological studies and innovative electrophysiology methods. We are fortunate to be able to have a group of outstanding international and national clinicians and neuroscientists to contribute to this symposium which provides a comprehensive up to date overview of a novel look at the MTLE which will be presented during the first day of the meeting. The second day of the meeting, there will be basic EEG topics followed by few hours dedicated for public awareness in Arabic and discussions. We would like to thank all the experts who involved a lot of thought and time to participate in this symposium to cover all aspects of MTLE. We also thank the attendants whose active participation in the discussion during the meeting. Welcome again and we hope that your time with us will be rewarding and memorable. Dr Radiah Saleem Al-Baradie President of the Symposium KING FAHAD SPECIALIST HOSPITAL - DAMMAM 8 General Overview Main sessions • Concepts and patho physiology at MTLE • Clinical characteristics of MTLE • Imaging in MTLE • Treatment of MTLE • Clinical and experiment of Neurophysiology of MTLE • Basic EEG Invaded disciplines • Physicians in the neurosciences field • Neurophysiologist • Healthcare providers interested in the field of epilepsy Learning activities • Highlight the challenges in the concept of MTLE • Review the semiology of MTLE in various ages • Discuss the various modalities in the diagnosis and management 9 KING FAHAD SPECIALIST HOSPITAL - DAMMAM Directors Sonia Khan, MD Prisedent of the Saudi Epiplpsey Socity Director of Clinical Neurosciences Military Hospital Riyadh Raidah Al-Baradie, MD Chairwoman of Symposium & Organizing Committee President of Saudi Chapter of Epilepsy Consultant Pediatric Neurologist/Epileptologist KFHS-D Shireen Qureshi, MD Consultant Neurologist Clinical Neurophysiologist, Saudi Aramco Dhahran Saeed Kadasah, MD Chairman of Psychiatry Department Consultant Psychiatry Military Hospital Riyadh Suad Al-Yamani, MD Consultant Pediatric Neurologist Director ADHD program King Faisal Specialist Hospital Riyadh Ali Al Gahtanti, PHD Consultant Neurophysiologist Riyadh Military Hospital KING FAHAD SPECIALIST HOSPITAL - DAMMAM 10 Directors Ahmed Al-Rumayyan, MD Pediatric Neurologist & Epileptologist, Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Associate Dean, Academic & Student Affairs, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh Assistant Professor, College of Medicine, Mohammed Jan, MD Professor and Consultant of Pediatric Neurology and Clinical Neurophysiology Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah Abdulrahman Sabbagh, MD Consultant Pediatric Neurosurgeon Sub-Specialty Consultant National Neurosciences Institute Assistant Professor of Neurosurgery Department of Neurosurgery King Saud bin Abdulaziz University for Health Sciences, Riyadh Ali Al Gahtanti, PHD Consultant Neurophysiologist Riyadh Military Hospital Director of EEG course Shireen Qureshi, MD Consultant Neurologist Clinical Neurophysiologist, Saudi Aramco Dhahran 11 KING FAHAD SPECIALIST HOSPITAL - DAMMAM Advisory Board Dr Reem Bunyan Dr Tarek Jallul Dr Khaled Darawil Dr Husam Al-Habib Dr Kamaleldin Hassan Dr Mahmoud Taha Dr Sonia Khan Dr Saad Shawan Dr Khalid Al-Quliti Dr Adnan Al- Sarawi Dr Mohamed Homan Dr Hani Al-Khaldi Dr Faisal Al-Otaibi Dr Waleed Tuwaijri Dr Shireen Qureshi Dr Faisal Awadelkarim Dr Ahmed Al Rumayan Dr Abdullah Al Baharani Dr Mohammed Domia Dr Adel Mohmen Dr Fadia Al Dahan Dr Talal Al-Harbi Dr El Amir Bachar Harfouch Dr Kefah Al Hayek Coordinators Mary Joseph Brent Hedgcock Aisha Ali Muaili Saleh Ali Safran Khalid Al RasheedDr Marizza Mercader Rawyah Mohsen Fares Al Zayer KING FAHAD SPECIALIST HOSPITAL - DAMMAM Manal Al Ghamdi Sabika Yousef Dossari Rami Ahmed Kilani Husam Kamal ElDeen Hanan Al Kanani Noor Al Huda Al-Karnous Hanadi Hassan Thiqa 12 International Faculty Dr Samuel Wiebe MD, MSc, FRCPC, FCAHS • Neurologist specializing in Epilepsy • Fellow of the Canadian Academy of Health Sciences • Associate Dean of Research, Faculty of Medicine, University of Calgary in Canada • Deputy Chair in the Department of Clinical Neurosciences, and Professor and Head Division of Neurology • Director of Clinical Research of the Hotchkiss Brain Institute in Calgary, Canada. • Past Kinsmen Chair for Paediatric Neurosciences. Current Hopewell Professor in Clinical Neurosciences Research. • Areas of academic interest: surgical trials in epilepsy, epidemiological studies, outcome assessment, and health services research • Roles in the International League Against Epilepsy (ILAE): Past-president of the Canadian League Against Epilepsy, past-chair of the North American Regional Commission of the ILAE, current Secretary-General of the ILAE, incoming Treasurer ILAE Ahmad Beydoun, M.D. Dr. Beydoun is currently Professor of Neurology at the American University of Beirut Medical Center and the Director of the Epilepsy Program. After completing his residency at the University of Cincinnati and fellowship at the University of Michigan Medical Center, Dr. Beydoun stayed on as a faculty member at the University of Michigan where he went up the rank to Professor of Neurology, Director of the Comprehensive Neurophysiology, Sleep and Epilepsy Program and Director of the investigational antiepileptic drug program. He is an internationally recognized authority in the field of epilepsy, has lectured extensively worldwide, was the principal investigator on more than 80 clinical trials and has more than 100 peer reviewed publications and book chapters. Dr Nizam Ahmed Dr Nizam Ahmed is an Associate Professor of Neurology and Director of the Clinical Neurophysiology laboratory at the University of Alberta. He is the President of the Canadian League against Epilepsy. Dr Ahmed graduated as a gold medalist from the Dow Medical College in Pakistan and completed his epilepsy training at the Yale University School of Medicine. He pioneered the first full time epilepsy telemedicine clinic in Western Canada and continues to serve on the educational taskforce of the International League against Epilepsy’s PECA program (partnering epilepsy centers of Americas). In collaboration with the Aga Khan University he has been actively involved in the set-up of a Comprehensive Epilepsy Program in Pakistan. He is one of the advisors at the American Academy of Neurology’s Advocacy Leadership Forum. Dr Ahmed has been the recipient of the A.B Baker Teaching Award by the American Academy of Neurology, Medical Services Delivery Innovative Fund award by the Capital Health Authority and Clinical Innovation Award by the Department of Medicine, University of Alberta. He has more than 40 peer reviewed clinical, educational and research publications. 13 KING FAHAD SPECIALIST HOSPITAL - DAMMAM National Faculty Bunyan, Reem MD Khan, Sonia MD Director Neurosciences Center Consultant Neurologist King Fahad Specialist Hospital Dammam Director of Clinical Neurosciences Military Hospital Riyadh Al-Twaijri, Waleed MD Al-Baradie, Raidah MD Consultant Pediatric Neurologist/Epileptologist, Director Comprehensive Epilepsy Program King Fahad Specialist Hospital-Dammam Jan, Mohammed MD Professor and Consultant of Pediatric Neurology and Clinical Neurophysiology Department of Pediatrics, Faculty of Medicine, King Abdulaziz University Jeddah Al-Rumayyan, Ahmed MD Pediatric Neurologist & Epileptologist, Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Professor, College of Medicine, King Saud Ben Abdulaziz University for Health Sciences, Riyadh Al-Bashiri, Fahad MD Consultant Pediatrician & Pediatric Neurologist College of Medicine & King Khalid University Hospital King Saud University, Riyadh, Saudi Arabia Al-Otaibi, Faisal MD Consultant Neurosurgeon King Faisal Specialist Hospital and Research Centre Riyadh Khalil, Mohamed MD Consultant Clinical Psychologist/Neuropsychologist Associate professor, department of psychiatry, College of medicine University of Dammam King Fahd Hospital of The University Khobar KING FAHAD SPECIALIST HOSPITAL - DAMMAM President of Pediatric Neurology Society Consultant Pediatric Neurologist King Abdulaziz Medical City Riyadh Baz, Salah MD Consultant Neurologist/ Epileptologist, Section of Adult Neurology, Department of Neurosciences, King Faisal Specialist Hospital and Research Centre Riyadh, Epilepsy Support and Information Center (ESIC) Vice president Jallul, Tarek MD Consultant Neurosurgeon Chairman of Neurosurgery King Fahad Specialist Hospital Dammam Al-Sarawi, Adnan MD Consultant Neurologist Residency Program Director King Fahad Specialist Hospital Dammam Al-Quliti, Khalid MD Consultant Neurologist Assistant professor, College of medicine, Taibah University Consultant Neurologist, King Fahad Hospital Medinah Mohamed, Kamaleldin Hassan MD Chairman, Mental Health Department Consultant Psychiatrist, King Fahad Specialist Hospital Dammam 14 National Faculty Qureshi, Shireen MD Muhaish, Husam MD Consultant Neurologist Clinical Neurophysiologist, Consultant Neuroradiologist King Fahad Specialist HospitalDammam Kanani, Hanan MD Fellow trainee Pediatric Department King Fahad Specialist Hospital Dammam Saudi Aramco, Dhahran Taha, Mahmoud MD Consultant Neurosurgeon King Fahad Specialist Hospital Dammam Jad, Lamyaa MD Consultant Pediatric Neurologist & Epileptologist Department of Pediatric Neurology National Neuroscience Institute King Fahad Medical City Al-Mubarak, Salah MD Consultant Pediatric Neurologist/ Epileptologist King Fahad Medical City, Riyadh Kanani, Hanan ,MD Housaawi, Yousef MD Fellow trainee Pediatric Department King Fahad Specialist Hospital Dammam Consultant Genetics and Metabolic Chairman; Pediatric Department King Fahad Specialist Hospital Dammam Bamgadem, Fawzia MD Consultant Neurologist and Epileptologist. Chairwoman of Neurology Department King Fahad Medical City Actor: Jelewi Mahdy Qahtani Moinuddin, Asif MD Consultant Nuclear Medicine, King Fahad Specialists Hospital, Dammam Baeesa, Saleh MD Associate Professor Neurosurgeon King Abdulaziz University and King Faisal Specialist Hospital, Jeddah Al-Khaldi, Hani MD Consultant Pediatric Neurologist King Fahad Specialist Hospital Dammam 15 KING FAHAD SPECIALIST HOSPITAL - DAMMAM List of Moderators Dr Samuel Wiebe, MD Mohammed Dad, MD MSc, FRCPC, FCAHS Professor Department of Clinical Neurosciences Consultant Pediatric Neurologist University of Taba’a Madina Ahmad Beydoun, M.D. Khaled Darawil, MD Professor of Neurology American University of Beirut Hospital Consultant Rehabilitation Medicine Chairman, Physical Medicine and Rehabilitation King Fahad Specialist Hospital – Dammam Mohammed Jan, MD Abdulaziz Al Samman, MD Professor and Consultant of Pediatric Neurology and Clinical Neurophysiology Department of Pediatrics, Faculty of Medicine, King Abdulaziz University Jeddah Chairman of Pediatric Neurology Consultant Pediatric Neurology King Fahad Medical City Riyadh Ali Al-Refai, MD Faisal Awad Al Kareem, MD Consultant Neurologist King Fahad Specialist Hospital Dammam Consultant Psychiatrist King Fahad Specialist Hospital Dammam Ali El Syed, MD Mohamed Homan, MD Consultant Pediatric Neurologist Military Hospital Dammam Consultant Neurosurgeon King Fahad Specialist Hospital Dammam Abdulrahman Al-Anazi, MD Saad Shahwan, MD Chairman Neurosurgery Department Vice President Neurosurgery Society Professor Neurosurgeon Dammam University Dammam Chairman, Pediatric Neurology Department Consultant Pediatric Neurologist Military Hospital Riyadh Syed Nizam Ahmed, MD Brahim Tabarki, MD Associate Professor of Neurology University of Alberta Edmonton, Alberta, Canada Consultant Pediatric Neurologist/Epileptologist Military Hospital Riyadh Talal Al-Harbi, MD Consultant Neurologist King Fahad Specialist Hospital Dammam Ahmed Ammar, MD Professor Neurosurgeon Dammam University Bandar Al Jefen, MD Consultant Adult Neurologist/Epileptologist King Saud University Riyadh Fadi Al-Ghareeb, MD Consultant Neurosurgeon Prince Sultan Medical City Riyadh KING FAHAD SPECIALIST HOSPITAL - DAMMAM 16 7th Annual Eastern Province Epilepsy Symposium General information Contact: Neurosciences Center E-mail: Raidah [email protected] [email protected] Fax: 03 8150315 Tele: Manal Al Ghamdi 03 8442222/2270 Web site: Fees Registration fee is 150 SR for physicians 50 SR for Nurses, Technologist, Medical Students Venue Sofitel Hotal – Khobar, at the corniche Paris Ballroom Registration Desk Located at the main entrance of the main conference hall of the Sofitel hotel, ground floor & opens daily from 07:30 am. All attendees are expected to report to registration desk in order to get their CME credit hours. Security – Access Please wear the symposium badges while you are in the venue. Meals Free snacks, coffee breaks, and lunch will be provided daily for registered attendees. The symposium badges should be presented all the time. Special invitation for free dinner and social activities will be provided at the registration desk during the meeting. CME The symposium and accredited by the Saudi Council for Health Specialties. Certificates will be available during the morning session of day two for registered attendees. CME/PD Accredited Hrs: 14 Accreditation Number: 32407/2013 Accreditation Date: 28-01-2013 17 KING FAHAD SPECIALIST HOSPITAL - DAMMAM Scientific Programme DAY 1 – Wednesday, April 10, 2013 MTLE TIME 07:00 – 08:00 TITLE SPEAKER Registration Session I Moderators : Dr Samuel Wiebe - Dr Syed Nizam Ahmed – Dr Saad Shahwan 08:00 –08:30 The concept of mesial temporal lobe epilepsy Dr Syed Nizam Ahmed 08:30 – 09:00 Epileptic Networks in Mesial Temporal Lobe epilepsy Dr Samuel Wiebe 09:00 – 09:20 Autoimmune encephalopathies and MTLE Dr Reem Bunyan 09:20 – 09:40 Genetics of mesial temporal lobe epilepsy and febrile seizure 09:40 – 09:50 Dr Yousef Housaawi Discussion 09:50 - 10:00 Coffee Break Session II Moderators: Dr Ahmad Beydoun – Dr Brahim Tabarki - Dr Faisal Awad Al Kareem 10:00 – 10:20 Mesial temporal lobe epilepsy: natural history and seizure semiology Dr Sonia Khan 10:20 – 10:40 Psychiatric and Cognitive symptoms and their treatment in temporal lobe epilepsy Dr Kamaleldin Hassan 10:40 – 11:00 The clinical syndrome of mesial temporal lobe epilepsy in children Dr. Raidah Al Baradie 11:00 – 11:20 Mesial versus neocortical temporal lobe epilepsy Dr. Mohammed Jan 11:20 – 11:30 Discussion 11:30 – 12:10 Opening Ceremony 12:10 – 01:10 Lunch and prayer Session III Moderators: Dr Ali Al-Refai – Dr Talal Al Harbi – Dr Ali El-Syed 01:10 – 01:40 Non-invasive and invasive EEG in mesial temporal epilepsy Dr Ahmad Beydoun 01:40 –02:00 MEG findings in medial temporal lobe Epilepsy Dr Salah Al-Mubarak 02:00 – 02:30 The relevance of high frequency oscillation in the path physiology and diagnosis of mesial temporal lobe epilepsy Dr Syed Nizam Ahmed 02:30 – 02:50 Structural imaging of mesial temporal lobe epilepsy Dr Husam Al Muhaish 02:50– 03:10 The role of cognitive FMRS in mesial temporal lobe epilepsy Dr Faisal Al Otaibi 03:10 – 03:30 The role of Wada test and functional transcranial Doppler sonography in pre surgical evaluation Dr Mohammed Khalil 03:30 –0 3:40 Discussion 03:40 – 03:50 Break Session IV Moderators: Dr Abdulrahman Al-Anazi – Dr Ahmed Ammar – Dr Mohamed Homan 03:50– 04:10 PET and ICTAL SPECT in MTLE Dr Asif Moinuddin 04:10 –04:30 Anti epileptic treatment of patient with MTLE Dr Hani Al-Khaldi 04:30 – 04:50 Depth electrodes (SEEG) in temporal lobe epilepsy Dr Tarek Jallul 04:50 - 05:10 Surgery for temporal lobe epilepsy pros, cons, and comparison between different procedures Dr Saleh Baeesa 05:10 – 05:30 Predictors of seizure outcome following resection for MTLE Dr Salah Baz 05:30 – 06:00 The role of automated seizure detection and Prediction Dr Samuel Wiebe 06:00- 06:10 Discussion & Conclusion Remarks 06:10 – 06:20 Break 06:20 – 08:00 SES Business Meeting 08:30 Gala Dinner KING FAHAD SPECIALIST HOSPITAL - DAMMAM 18 Scientific Programme DAY 2 – Thursday 11th of Apirl 2013 EEG course & public awareness program Time Topic Speaker Chairpersons: Dr Abdulaziz Al-Samman – Dr Khaled Darawil – Dr Bandar Al Jefen 08:00-08:20 Role of EEG in epilepsy Dr Fawzia Bamgadem 08:20-08:40 Applications of different montages Dr Lamyaa Ali Bakr Jad 08:40-09:00 Polarity conventions and sources localization Dr Shireen Qureshi 09:00-09:20 Common EEG patterns Dr Waleed Al-Twajeri 09:20-09:40 EEG in brain death and coma Dr Fahad Al Bashiri 09:40-09:50 09:50-10:00 Discussion Coffee break 09:00 – 10:00 Public Registration Epilepsy awareness day (Arabic) Chairpersons: Dr Fadi Al-Ghareeb – Dr Mohammed Jan – Dr Mohammed Dad 10:00-10:05 Welcome and introduction مقدمة و ترحيب Dr Raidah Al-Baradie 10:05-10:20 Definition, etiology, classification, and semiology ماهو الصرع واعراضه ومسبباته Dr Sonia Khan 10:20-10:35 Epilepsy diagnosis تشخيص الصرع والفحوصات الالزمة Dr Adnan Al-Sarawi Acute and chronic medical management العالج الدوائي ملرض الصرع Dr Ahmed Al-Rumayyan 10:50-11:05 Epilepsy surgery العالج اجلراحي ملرض الصرع Dr Mahmoud Taha 11:05-11:20 How to live with epilepsy? كيفية التعامل مع مرض الصرع Dr Khalid Al-Quliti 11:20-11:35 Epilepsy & learning disability الصرع و صعوبات التعلم 10:35 – 10:50 Dr Hanan Al -Kanani 11:35-12:00 Actor: Jelewi Mahdy Qahtani 12:00 – 13:00 Discussion & Conclusion Remarks 13:00 Prayer and lunch 19 KING FAHAD SPECIALIST HOSPITAL - DAMMAM Abstracts The Concept of Mesial Temporal Lobe Epilepsy Mesial Temporal Lobe Epilepsy (MTLE) is identified by its clinical presentation, and the diagnosis is supported by ancillary studies including structural and functional imaging, electroencephalographic signatures and neuropsychological profile. Approximately one third of patients with MTLE are resistant to the current antiepileptic medications and qualify as potential candidates for resective epilepsy surgery. Up to sixty percent of patients with MTLE who undergo surgery can either become seizure free or can be rendered free of disabling seizures after an anterior temporal lobectomy or a selective amygdalohippocampectomy. This presentation will briefly review some historical aspects of MTLE, its clinical presentation, diagnosis and management. Dr Nizam Ahmed Associate Professor of Neurology Director of the Clinical Neurophysiology laboratory - University of Alberta Autoimmune Encephalopathies and MTLE Reem Bunyan, MD MS (CTS) Director, Neurosciences Center Consultant Neurologist King Fahad Specialist Hospital-Dammam KING FAHAD SPECIALIST HOSPITAL - DAMMAM 20 Abstracts Epileptic Networks in Mesial Temporal Lobe epilepsy The concept of the “Epileptogenic zone” has served us well for many years. It has provided the basis for semiological understanding of focal ictal symptoms and their propagation. Furthermore, it provides the substrate for surgical resection targets. However, there is growing evidence from recent advances in neuro-imaging that focal seizures and focal epilepsies are in fact caused by the abnormal function of a network of cortical and sub-cortical brain structures rather than by a single epileptogenic region. As stated by Vulliemoz, combining the concept of the epileptogenic zone and the network approach, seizure freedom could be reached without the necessity to remove the entire network. Indeed, resection of a node or interruption of a critical connection of the network could sufficiently alter the network to suppress its epileptogenicity. We review various methods of assessing epileptic networks in temporal lobe epilepsy, and salient findings in these methods. Prominent among these methods is interictal and ictal EEGfMRI studies in Temporal lobe epilepsy. Interictal studies show significant activation clusters in the mid–cingulate gyri bilaterally, and in the ipsilateral insula, mesial and lateral temporal regions, and cerebellum. Significant deactivations are found bilaterally in the inferior parietal lobules, posterior cingulate cor- tex, and precuneus and in the contralateral posterior temporal cortex. The relevance of these findings as they pertain to surgical decision-making and surgical prognosis is being investigated. Samuel Wiebe, MD, MSc, FRCPC MD, MSc, FRCPC, FCAHS Genetics of mesial temporal lobe epilepsy and febrile seizure Yousef Housaawi, MD Consultant Genetics and Metabolic Chairman; Pediatric Department King Fahad Specialist Hospital-Dammam 21 KING FAHAD SPECIALIST HOSPITAL - DAMMAM Abstracts Mesial Temporal Lobe Epilepsy Natural history and Clinical Semiology Mesial Temporal lobe epilepsy (MTLE) represents the most common medically intractable epilepsy undergoing epilepsy surgery. MTLE in many instances begin in infancy or early childhood after an initial precipitating event. The first epileptic seizure often occurs after a variable latent period after this event. The precise natural history and progression following the first seizure to the development of MTLE, its spontaneous remission or the development of treatment resistant epilepsy remain poorly understood with limited understanding of the role played by these initial events, the subsequent latency to development of temporal lobe epilepsy, and the emergence of treatment resistance. Current data suggest that MTLE is a heterogeneous condition, where the age of onset, presence or absence of a lesion on neuroimaging, the initial precipitating event, association with febrile seizures, febrile status epilepticus, and neurotropic viral infections influence the natural history and outcome. The pathways and processes through which these variables interact will provide the basis for understanding the natural history of MTLE. The limitations of most studies include the retrospective nature, the lack of longitudinal and observational studies, and weaknesses in study design. MTLE with hippocampal sclerosis is commonly associated with history of febrile convulsions. Seizure auras are common in TLE patients and often exhibit features that are relatively specific for TLE but few are of lateralizing value. Ipsilateral automatisms with contralateral dystonia however, often have lateralizing significance. Careful study of seizure semiology remains invaluable in addressing the search for the seizure onset zone. Dr. Sonia Khan, FRCP (Lond), FRCP (Edin) Consultant Neurologist / Epileptologist Department of Neurology, Prince Sultan Military Medical City KING FAHAD SPECIALIST HOSPITAL - DAMMAM 22 Abstracts Psychiatric and Cognitive Symptoms in Temporal Lobe Epilepsy and their Treatment Mesial temporal lobe epilepsy is one of the most common forms of temporal lobe epilepsy (TLE); its pathophysiological substrate is usually hippocampal sclerosis, the most epileptogenic lesion encountered in patients with epilepsy. Mesotemporal structures of the limbic system have been implicated in the etiology of major psychiatric disorders-such as schizophrenia- that occur independently of epilepsy. Psychiatric and cognitive symptoms are often a feature of the TLE seizure itself (ictal). Interictal psychiatric disorders include: cognitive dysfunction (including memory impairments), psychotic; depressive; anxiety; phobic and obsessive compulsive disorders and personality changes (disorder). Other cognitive symptoms may include ictal and postictal confusional syndromes. In addition, co morbid major psychiatric disorders such as schizophrenia and bipolar affective disorder may occur in TLE. Antiepileptic drugs (AED) can contribute to the development of psychiatric and cognitive symptoms in TLE. Management of psychiatric and cognitive symptoms in TLE include psychopharmacological and psychosocial interventions, as well as well as treating the underlying cause (epilepsy) and managing AED . The presentation will address and highlight these issues. Mohamed, Kamaleldin Hassan MD Chairman, Mental Health Department Consultant Psychiatrist, King Fahad Specialist Hospital-Dammam 23 KING FAHAD SPECIALIST HOSPITAL - DAMMAM Abstracts The Clinical Syndrome of Mesial Temporal Lobe Epilepsy in Children Mesial temporal lobe epilepsy (MTLE) is described as a discrete syndrome in adults with temporal lobe epilepsy (TLE) and associated hippocampal sclerosis (HS). Early diagnosis of MTLE can be especially important in medically refractory cases when antero-mesial temporal lobectomy may eliminate seizures. Epileptic seizures of MTLE patients typically start at the end of first decade of life, and these seizures initially respond well to antiepileptic drugs (AED) treatment during the first year of the syndrome. Thus, the characteristic clinical picture of MTLE is rarely observed in children. In the report by Murakami et al. (1996), 19 patients (0.8%) of total of 2,319 children with epilepsy were identified to have MTLE syndrome. In this talk, I will describe not only the typical features of childhood MTLE, its prognosis in children, and impact on the developing brain, but also assess the presence of hippocampal abnormalities in children without MTLE. Childhood TLE due to mesial temporal lesions other than HS (e.g. dysplasia, tumors) is more frequent than the classic MTLE syndrome in adults. Raidah Al-Baradie, MD Consultant Pediatric Neurologist/Epileptologist, Director Comprehensive Epilepsy Program King Fahad Specialist Hospital-Dammam Mesial versus neocortical temporal lobe epilepsy Temporal lobe epilepsy (TLE) is the most common form of adult localization-related epilepsy. Hippocampal onset accounts for at least 80% of all temporal lobe seizures. While mesial temporal lobe epilepsy (mTLE) is a well-recognized cause of complex partial seizures, neocortical temporal lobe epilepsy (nTLE) albeit being less common is increasingly recognized as separate disease entity. Differentiating the two remains a challenge for epileptologists as many symptoms overlap due to reciprocal connections between the neocortical and the mesial temporal regions. NTLE comprises a heterogeneous group of epilepsies with focal seizures characterized by auditory, somatosensory, or psychic auras followed by motionless staring, early contralateral clonic activity often secondarily generalizing. Various studies have attempted to correctly localize the seizure focus in nTLE as patients with this disorder may also benefit from surgery. While earlier work predicted poor outcomes in this population, recent work challenges those ideas yielding good outcomes in part due to better localization using improved anatomical and functional techniques. Mohammed M.S. Jan, MD, FRCPC Professor and Consultant of Pediatric Neurology, Department of Pediatrics Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia KING FAHAD SPECIALIST HOSPITAL - DAMMAM 24 Abstracts Non-invasive and invasive EEG in mesial temporal epilepsy The major aim in the presurgical evaluation of patients with refractory localization related epilepsy is the determination of the epileptogenic zone. To that end, one relies on the concordance of data derived amongst others from the semiology of the seizures, interictal and ictal EEG, and neuroimaging. Patients with mesial temporal lobe epilepsy have a typical semiology and neuroimaging studies frequently show evidence of mesial temporal sclerosis or a lesion involving the mesial temporal structures. Noninvasive interictal and ictal EEG recordings are frequently used to try to delineate the irritative and ictal onset zones in patients with MTLE. Since spikes originating from the hippocampus and medial temporal structures are frequently not seen on the surface EEG, special electrodes in addition to those placed according to the 10-20 system are used. These include the sphenoidal, true anterior temporal and/or the FT9/FT10 sites of the 10-10 system. The importance of the interictal discharges in patients with MTLE is illustrated by a number of studies that showed that a single interictal focus localized to the anterior temporal region accurately predicted temporal lobe onset irrespective of the ictal findings on surface recordings. Seizure outcome after anterior temporal lobectomy (ATL) was comparable whether or not video-EEG monitoring was performed in patients with unilateral temporal interictal discharges concordant with neuroimaging and functional studies, emphasizing the importance of the interictal EEG. The most specific pattern on the surface EEG in mesial temporal onset is a rhythmic discharge of 5-9 Hz maximal over the sphenoidal or anterior temporal electrode sites. Other ictal pattern are more likely to be associated with a neocortical temporal onset. Patients with bilateral independent interictal temporal epileptiform discharges are more likely to have independent bitemporal seizures. A minimum of four seizures need to be recorded to identify independent temporal ictal onset and up to six seizures might need to be recorded if the first seizure was non localized. The need for invasive monitoring in MTLE has drastically diminished since the introduction of high resolution brain magnetic resonance imaging. Invasive monitoring is still required in selected cases with evidence of bilateral mesial temporal sclerosis that could not be lateralized with non invasive testing. It is also required if neocortical temporal lobe epilepsy or temporal lobe epilepsy “plus” are suspected. Ahmad Beydoun, M.D. Professor of Neurology American University of Beirut 25 KING FAHAD SPECIALIST HOSPITAL - DAMMAM Abstracts Diagnostic Value of Magnetoencephalogram Localization in Temporal Lobe Epilepsy Temporal lobe epilepsy (TLE) is the most common type of epilepsy requiring surgical intervention, because 70-80% of patients become seizure-free after epilepsy surgery. The focal epileptic activity generated by the epileptic network is located within one anatomical lobe in the majority of cases. The decision for surgery relies on the findings of several diagnostic procedures, in order to delineate the epileptogenic zone. Interictal spiking is important in clinical diagnosis of partial epilepsy, and guide surgical resection. Unlike ictal onset region, interictal spikes may predict the irritative epileptogenic zone and map the potential epileptogenic zone in a precise pattern beyond the ictal onset area. Complete resection of interictal spikes area identified by intracranial EEG is associated with favourable seizure outcome. Magnetoencephalogram (MEG) records delicate magnetic signals, which is high in temporal resolution in the order of milliseconds, which is valuable in localizing epileptogenic zone. These magnetic signals are non-invasive, had wide cranial coverage and minimally distorted when recorded than electric signals, resulting in optimal spatial resolution that could be useful in directing epilepsy surgery resection. Magnetic field generated by intracranial neuronal activities, such as epileptic discharges are analyzed by an equivalent-current dipole model to estimate the location of the spikes sources. The source locations are then overlaid onto MR images of the corresponding area, a technique called magnetic source imaging. The overlays show the spatial relation between epileptogenic tissue, defined by MEG spikes sources, and the lesion revealed by MRI. Several studies demonstrated that MEG spikes had concordance with intracranial EEG findings and had lead to successful epilepsy surgery outcome (e.g. anterior temporal lobe epilepsy). Nevertheless, MEG spikes localization had superior value in delineating the epileptogenic zone, when had compared to other pre-surgical procedures (such as Video-EEG, SPECT, and PET). Our aim is to explore the robust clinical role of MEG in diagnosing temporal lobe epilepsy. Dr Salah Almubarak MEG Lab, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia KING FAHAD SPECIALIST HOSPITAL - DAMMAM 26 Abstracts The Relevance of High Frequency Oscillations in the Pathophysiology and Diagnosis of MTLE High Frequency Oscillation (HFO) is a relatively new biomarker of human epileptogenic tissue, identified almost 20years ago. The exact pathophysiology of HFOs is still unclear, although it has been suggested that this activity is related to asynchronous firing of a population of neurons. HFOs can be identified from intracranial EEGs recorded at a sampling rate of 2000 Hz or more. Review of HFOs requires analysis of the intracranial EEGs at specific filter settings reviewed at relatively high gains and expanded time scale. This presentation will define HFOs, discuss the current understanding of their pathophysiology, discuss the technical requirements to record and review HFOs and finally the relevance of HFOs to MTLE. Dr Nizam Ahmed Associate Professor of Neurology Director of the Clinical Neurophysiology laboratory University of Alberta Structural imaging of mesial temporal lobe epilepsy Husam Muhaish, MD Consultant Neuroradiologist King Fahad Specialist Hospital- Dammam 27 KING FAHAD SPECIALIST HOSPITAL - DAMMAM Abstracts Proton Magnetic Resonance Spectroscopy in Patients with Mesial Temporal Lobe Epilepsy Proton Magnetic Resonance Spectroscopy (MRS) has been employed in the pre-surgical evaluation of patients with medically refractory mesial temporal epilepsy. Several studies have evaluated the role of MRS in the assessment of the temporal lobe biochemical profile. MRS was shown to predict the response to antiepileptic drugs based on the assessment of the degree of neuronal and axonal damage. More over, MRS can provide valuable information about the location of functional abnormalities within the temporal lobe. In some cases, there is a neocortical abnormalities associated with or without hippocampal pathology. MRS would be of benefit to assess for any neocortical involvement and therefore will help in selecting the most suitable surgical approach. More over, MRS can identify any abnormalities within the contralateral temporal area, which may improve our knowledge about the prediction of surgical outcome. Further validation of the previous studies results is necessary to better define the role of MRS in temporal lobe epilepsy. Faisal Al-Otaibi, MD Consultant Neurosurgeon King Faisal Specialist Hospital and Research Centre Riyadh, Saudi Arabia Depth electrodes (SEEG) in temporal lobe epilepsy Tarek Jallul, MD Deputy Director Neuroscience Center Chairman; Neurosurgery Department Consultant Neurosurgeon King Fahad Specialist Hospital – Dammam KING FAHAD SPECIALIST HOSPITAL - DAMMAM 28 Abstracts The Role of Wada Test And Functional Transcranial Doppler Sonography In Presurgical Evaluation During the past decade, there have been significant changes in the uses and role of WADA procedure in epilepsy surgery program. One major reason for this change is the advent of new non-invasive neuroimaging techniques that are proposed as alternative to WADA. Other reasons are related to practicality, and convenience of the WADA rather than to its accuracy and validity. However, WADA is stills the gold standard procedure for presurgical evaluations in epilepsy surgery. This presentation is an attempt to give an updated overview of the available data about the performance of the alternative procedure, compared to WADA. Examples of some experimental and neuropsychological methods and procedures that have been used in lateralization of function will also be outlined. An overview of the alternative neuroimaging techniques that have shown some promising data and are being used in many centers will be given. These noninvasive or minimally invasive techniques include functional magnetic resonance imaging (fMRI), positron emission tomography (PET), single-photon emission computed tomography, transcranial magnetic stimulation, near infrared spectroscopy and functional transcranial Doppler monitoring (fTCD). Some of these procedures are being used for both lateralization and localization of language function in epilepsy surgery candidates. The fTCD will be taken as an example of alternative that represent a practical and cost effective technique. Samples of the results of using related non invasive techniques will also be described, together with the advantage and disadvantage of each procedure. Dr. Mohamed Salah Khalil (PhD. Neuropsychology) Associate Professor/Consultant of Clinical Psychology Director of Postgraduate Program in Clinical Psychology Department of Psychiatry University of Dammam 29 KING FAHAD SPECIALIST HOSPITAL - DAMMAM Abstracts Role of SPECT and PET Imaging in Medial Temporal Lobe Epilepsy F-18 fluorodeoxyglucose (F18-FDG) positron emission tomography (PET) and technetium labeled (Tc-99m) single-photon emission computed tomography (SPECT) agents have emerged as complimentary noninvasive modalities to electroencephalogram (EEG) and magnetic resonance imaging (MRI) for the successful surgical management in patients with epileptic seizures. They are more sensitive in evaluation of medial temporal lobe epilepsy (MTLE) versus extra temporal lobe epilepsy (ETLE). In MTLE, their role is superior to MRI if there is no anatomical change on MRI, uncertain unilateral changes on MRI or symmetric changes on MRI. Asif Moinuddin, MD Consultant Nuclear Medicine, King Fahad Specialists Hospital - Dammam KING FAHAD SPECIALIST HOSPITAL - DAMMAM 30 Abstracts Antiepileptic Treatment of Patient With Mesial Temporal Lobe Epilepsies Antiepileptic treatment of patient with Mesial temporal lobe epilepsies (MTLEs) remains one of the cornerstones of management due to natural course of the disease and the long duration of active seizure and remains so after surgery wither surgery was successful or not. MTLEs are most common refractory partial epilepsy, and most often treated surgically. Current literature therefore focuses on surgical outcome distracted from producing randomized trials to inform clinician appropriately about Antiepileptic treatment. Among other concepts it is only fair to verify our own management objectives being Seizure freedom versus further medication freedom . About 47-60% of new-onset partial seizures are controlled effectively by the first drug. Studies in have shown that the 3 major AEDs, phenytoin, carbamazepine, and valproate, are equally effective in controlling partial seizures. The newer AEDs, such gabapentin, topiramate, lamotrigine, levetiracetam, oxcarbazepine, and zonisamide, have similar efficacy than the older AEDs, but they stand out predominantly in having far less side effects, as well as in long-term side effects and having far fewer drug-drug interactions than do the older AEDs. Some antiepileptics have antidepressants effects that boost their level of serotonin, stops kindling, and seizures become much more difficult to induce. Neuroprotective versus non neuroprotective selection among AED's is still debatable. There is lack of long-term Prognostic investigations of patients with MTLE who receive only drug treatment. Early drug responsiveness in them is not well defined and the benign cases which can be identified represent most likely patients who have relapsing remitting course which may substantially delay referral for epilepsy surgery. Abnormal neurological examination, high seizure frequency from the onset and poor response to antiepileptic drug treatment remain best predictors of poor prognosis and drug resistance. Non-surgical MTLE drug-resistant patients can achieve long seizure-free periods with AED, but relapses are common. Generally, a good candidate for stopping AEDs has focal pathology, is completely seizure free, had an anterior temporal lobe resection, complete resection of seizure focus, and has no epileptiform discharges on postoperative EEG. Tapering AEDs, independently of its timing, will induce seizure recurrence in about a third of patients. However, patients relapsing after tapering AEDs regain control after resuming therapy. Time of discontinuation of AEDs after should be tailored for each patient. In an optimal constellation, substantial AED reduction with the goal of a monotherapy can be advised after 1 year and discontinuation 2 years after surgery. Advance in understanding of drug resistance (drug receptors, transport, BBB, sprouting…etc) itself is an area of attraction and the development of markers for pharmacoresistence is a targeted outcome. Activated astrocytes are a common hallmark in patients with MTLE and represent a promising new target for the development of antiepileptic drugs. Hani Al-Khaldi, MD Consultant Pediatric Neurologist King Fahd Specialist Hospital - Dammam 31 KING FAHAD SPECIALIST HOSPITAL - DAMMAM Abstracts Surgery for Temporal Lobe Epilepsy: Pros and Cons, and Comparison between Different Procedures There is clear evidence that surgery is the most effective treatment for intractable temporal lobe epilepsy (TLE) than medical therapy. Advances in electrophysiology and neuroimaging have led to a more precise localization of the epileptogenic zone and structural abnormality within the temporal lobe. There are a variety of surgical techniques employed for TLE that provide an effective treatment with significant preservation of neurological function and acceptable surgical risks. These techniques mainly target the mesial structures, employing either resection, with or without variable degree of lateral neocortical resection, or disconnection. The different types of surgical techniques are described herein with emphasis on the advantages and complications particularly related to cognitive function, and seizure outcome of each technique. Saleh S. Baeesa, MBChB, FRCSC Associate Professor of Neurosurgery Faculty of Medicine King Abdulaziz University -Jeddah KING FAHAD SPECIALIST HOSPITAL - DAMMAM 32 Abstracts Surgical outcome and predictors of temporal lobe epilepsy surgery in KFSHRC, Riyadh, Saudi Arabia Author(s): Baz S1, althubaiti I1, alotaibi F1, aldhalan H1, yamani S1, alsemari A1 Institute(s): 1King Faisal Specialist Hospital and Research Centre, Neurosciences, Riyadh, Saudi Arabia Purpose: To present the epilepsy outcome from epilepsy surgery and to address the predictors that may impact outcome Method: The data was extracted from epilepsy registry in our epilepsy program. 12, 36 and 60 months epilepsy outcome was studied against several predictors' then logistic regression analysis was applied to identify the significant predictors. Results: 295 temporal lobe epilepsy surgeries were performed between 1998 and 2012 .At 12 months, 172 patients (58%) were seizure free without aura while 17 (5.7%) had aura and 46 (15.5%) had 1-3 seizures per year, with total of 79.6% Engle class one outcome. At 36 months, 195 patients had 74.2% Engle class1; divided in 105 (53%) seizure free, 13 (6.6%) had aura and 27 (13.8%) 1-3 seizure per year. At 60 months, 47% were seizure free, 9% had only aura and 11% of 100 patients followed up with 67% Engle Class 1 outcome. The regression analysis was insignificant for any of the variables tested including febrile convulsion, family history, CNS trauma, CNS infection, histopathology, MRI or PET findings, inter-ictal EEG findings, duration of the epilepsy and history of mental retardation. Conclusion: Temporal lobe epilepsy surgery has rewarding outcome. No predictor can be identified to show direct impact on the epilepsy surgery outcome. Salah Baz, MD Consultant Neurologist/ Epileptologist, Section of Adult Neurology, Department of Neurosciences, King Faisal Specialist Hospital and Research Centre Riyadh, Epilepsy Support and Information Center (ESIC) Vice president 33 KING FAHAD SPECIALIST HOSPITAL - DAMMAM Abstracts Role of Automated Seizure Detection and Prediction At the core of any system or algorithm to detect seizures automatically is the definition of what constitutes a seizure. Conceptual and operational definitions are not universally agreed upon. These, in addition to the indescribable contribution of the experienced Gestalt, contribute to the limitation of automated seizure detection. Various mathematical models have been proposed to overcome the limitations created by this complex system. Important elements that can contribute towards optimum seizure detection include the use of microelectrodes, high-frequency oscillations, high sampling rate, high-density arrays, and modern analysis techniques. Extracerebral markers of seizure onset, such as heart rate and motor changes, are also being explored as reliable and easily applicable automated seizure detection methods. The accuracy of commonly used automated seizure detection systems is described. The promise of seizure prediction is that it will enable patients and clinicians to reliable abort seizures before they begin. Devices are being designed using a variety of computational and mathematical algorithms for seizure prediction. The concept of transition of brain dynamics is one of several frameworks being used to predict seizure occurrence automatically. This is based on the observation that seizures do not start abruptly, but rather are preceded by a gradual resetting of brain dynamics lasting minutes to hours. Other methods include electrical stimulation to “probe” the brain for seizures. The main methods of seizure prediction are explored. Samuel Wiebe MD, MSc, FRCPC MD, MSc, FRCPC, FCAHS Montage Applications TIdentification and classification of EEG activity is based on accurately localizing cortical activity. This consists of two steps: (1) localizing EEG activity to specific electrode positions on the scalp and (2) relating the scalp localization to the likely source in the underlying cerebral cortex. Montages are spatial filters that emphasize different aspects of the scalp topography of EEG voltage fields. Different types of montages are used to assess cortical electrical activity In this talk we will be looking at types of montages and how they help in interpreting the EEG as well as common pitfalls and caveats in source localization. Lamyaa Jad, MD Consultant Pediatric Neurologist & Epileptologist Department of Pediatric Neurology National Neuroscience Institute King Fahad Medical City KING FAHAD SPECIALIST HOSPITAL - DAMMAM 34 Abstracts The Role of EEG in Epilepsy The human electroencephalogram (EEG) was discovered by the German psychiatrist, Hans Berger, in 1929. Its potential applications in epilepsy rapidly became clear, when Gibbs and colleagues in Boston demonstrated 3 per second spike wave discharge in what was then termed petit mal epilepsy. EEG continues to play a central role in diagnosis and management of patients with seizure disorders—in conjunction with the now remarkable variety of other diagnostic techniques developed over the last 30 or so years—because it is a convenient and relatively inexpensive way to demonstrate the physiological manifestations of abnormal cortical excitability that underlie epilepsy. Electroencephalography (EEG) is the most specific method to define epileptogenic cortex. Its sensitivity and specificity depend on several factors such as age and recording procedures, for example, sleep recordings and activation procedures (hyperventilation, photic stimulation). EEG reveals characteristic findings in several epilepsy syndromes. Rarely, epileptiform discharges are recorded in healthy, particularly young individuals. Ictal video/EEG recording is considered to be critical in localizing the epileptogenic zone. A careful analysis of the first clinical signs and symptoms of a seizure and of the evolution of the seizure symptomatology can provide important localizing clues. Although surface EEG recordings are less sensitive than invasive studies, they provide the best overview and, therefore, the most efficient way to define the approximate localization of the epileptogenic zone. Invasive recordings are used in patients in whom the epileptogenic zone either cannot be located with noninvasive diagnostic methods or is adjacent to eloquent cortex. The most commonly used invasive electrodes are stereotactically implanted depth electrodes and subdural strip or grid electrodes. Foramen ovale and epidural electrodes are of intermediate invasiveness, but less sensitive. Invasive electrodes are subject to sampling errors if misplaced and should be used only after exhaustive noninvasive evaluations have (1) failed to localize the epileptogenic zone and (2) led to a testable hypothesis regarding this localization. Invasive EEG studies are associated with additional risks that are justifiable only if there is a good chance of obtaining essential localizing information and on a potentially resectable area. Epileptiform activity is specific, but not sensitive, for diagnosis of epilepsy as the cause of a transient loss of consciousness or other paroxysmal event that is clinically likely to be epilepsy. EEG has relatively low sensitivity in epilepsy, ranging between 25–56%. Specificity is better, but again variable at 78–98%. About 50% of patients with epilepsy show IED in the first EEG test. Yield in adults can be increased by repeating the routine EEG (up to four recordings), and in all ages by use of sleep studies. The combination of wake and sleep records gives a yield of 80% in patients with clinically confirmed epilepsy. EEG helps determine seizure type and epilepsy syndrome in patients with epilepsy, and thereby choice of antiepileptic medication and prediction of prognosis. EEG findings contribute to the multi-axial diagnosis of epilepsy, in terms of whether the seizure disorder is focal or generalized, idiopathic or symptomatic, or part of a specific epilepsy syndrome. It helps in predicting the seizure recurrence, cases of cognitive changes and any attacks of loss of consciousness. EEG is essential for correct diagnosis and management of status epilepticus, weather convulsive or nonconvulsive type and in their proper management. Fawziah Bamogaddam, MD. Consultant in Neurology, Epilepsy and Sleep Disorders. MEG Specialist. Neurology Department, NNI, KFMC Riyadh, Saudi Arabia 35 KING FAHAD SPECIALIST HOSPITAL - DAMMAM Abstracts Polarity convention and source localization The Art and Science of EEG reading is harmonious in way of recognition of waveforms ( spikes, sharp waves and slow waves) and principles of neurogenerator localization in the brain. Solid angle theorem provides rational basis for principle of EEG localization. This will be well explained in systematic review of EEG reading based on waveform recognition with respect to polarity convention and localization of neurogenerators. Shireen Qureshi MD, FRCPC Consultant Neurologist/ Clinical Neurophysilogist Saudi Aramco Common EEG patterns Waleed Al-Twaijri, MD President of Pediatric Neurology Society Consultant Pediatric Neurologist King Abdulaziz Medical City-Riyadh KING FAHAD SPECIALIST HOSPITAL - DAMMAM 36 Abstracts Electroencephalography (EEG) in coma and brain death Background : Coma is an unarousable psychologic unresponsiveness in which the subject lies with eyes closed (Plum & Posner, 1980).Brain death is a permanent , irreversible brain damage resulting in loss of brain function. EEG is a valuable tool in the evaluations of patients with coma or brain death . Objectives : EEG is an important in evaluation of children with coma . EEG allows for an immediate examination of cortical or cortical–subcortical dysfunction in an inexpensive, safe, and readily available manner in the intensive care unit. EEG in intensive care unit is often contaminated by artifacts arising from monitoring equipment, life support systems, and personnel . When recording comatose patients, it is important to test for reactivity. The EEG may be of prognostic value in the etiology of the coma and progression of the encephalopathy. Determination of death is primarily considered to be clinical and EEG is ancillary test in the confirmation of brain death when the clinical assessment is difficult or impossible . There is a specific procedure to perform an EEG to confirm the diagnosis of brain death. The term electrocerebral inactivity (ECI) is often used to describe EEG features during brain death. Dr.Fahad Abdu Bashiri Head, Pediatric Neurology Unit Consultant Pediatric Neurologist & Epileptologist Clinical assistant Professor,Department of Pediatrics, Faculty of Medicine & King Khalid University Hospital King Saud University,Riyadh,Saudi Arabia 37 KING FAHAD SPECIALIST HOSPITAL - DAMMAM Sponsors KING FAHAD SPECIALIST HOSPITAL - DAMMAM 38
