Telemedicine has taken great strides in the last ten years. It is no longer a novel concept and is routinely used by many primary and tertiary care centers for clinical care. The concept is quite simple. Two centers separated in space are connected through a telecommunication network. Although strictly speaking even a phone call between two physicians can be considered telemedicine, the term is generally applied to an interactive videoconference. Telemedicine has added a new dimension to global care and global collaborations.We have successfully established telemedicine collaboration between the University of Alberta Hospital (UAH), Canada and ABSTRACT: Objective: Our main objective was to use videoconferencing as a primary means to: a) assist in launching an epilepsy surgery program in Pakistan; 2) participate in case conferences on complex epilepsy patients in each country. Methods: Extensive testing using both point to point and bridged integrated service digital network (ISDN) and internet protocol (IP) connections was carried out using bandwidths of 384-768 kilobits per second (kbps). Videoconferences between sites were arranged two to three weeks in advance and connections were tested a day prior to the scheduled conference. Sharing of PowerPoint presentations, neuroimaging and video-EEG was available to all sites. Discussions centered on patients with medically refractory epilepsy. Results: Between July 2006 and June 2008, 17 sessions were booked. Five of these conferences bridged in specialists from West Virginia University. Most successful connections occurred using IP point to point calls or a bridge connecting end points through IP at 512 kbps. We conducted three surgeries for medically refractory temporal lobe epilepsy in Pakistan. At follow-up in January 2009, two patients have been seizure free and one had two breakthrough seizures after sudden unsupervised discontinuation of Levetiracetam. Conclusion: Our international tele-epilepsy collaboration has proven feasible and valuable to all participants. Our experience suggests considerable thought and preparation are needed before a teleconference to ensure its success. We provide a recipe to set-up similar telemedicine collaborations. Considerations include time zone differences, equipment type, interoperability between endpoints, connection capabilities, bandwidth availability, and backup plans for unsuccessful connections. Telemedicine can facilitate epilepsy care around the world, identifying with the concept of a "Global Health Village". Cette collaboration internationale en télé-épilepsie s'est avérée réalisable et avantageuse pour tous les participants. Notre expérience indique qu'on doit la préparer avec soin afin d'assurer son succès. Nous recommandons une marche à suivre pour mettre sur pied de telles collaborations en télémédecine. On doit porter une attention particulière aux différents fuseaux horaires, au type d'équipement, à l'interopérabilité entre les sites, aux capacités de connexion, à la disponibilité de bandes passantes et prévoir...

Background. Developing countries, home to 80% of epilepsy patients, do not have comprehensive epilepsy surgery programs. Considering these needs we set up first epilepsy surgery center in Pakistan. Methods. Seventeen teleconferences focused on setting up an epilepsy center at the Aga Khan University (AKU), Karachi, Pakistan were arranged with experts from the University of Alberta Hospital, Alberta, Canada and the University of West Virginia, USA over a two-year period. Subsequently, the experts visited the proposed center to provide hands on training. During this period several interactive teaching sessions, a nationwide workshop, and various public awareness events were organized. Results. Sixteen patients underwent surgery, functional hemispherectomy (HS) was done in six, anterior temporal lobectomy (ATL) in six, and neuronavigation-guided selective amygdalohippocampectomy (SAH) using keyhole technique in four patients. Minimal morbidity was observed in ATL and, SAH groups. All patients in SAH group (100%) had Grade 1 control, while only 5 patients (83%) in ATL group, and 4 patients (66%) in HS group had Grade 1 control according to Engel's classification, in average followups of 12 months, 24 months and 48 months for SAH, ATL, and HS, respectively. Conclusion. As we share our experience we hope to set a practical example for economically constrained countries that successful epilepsy surgery centers can be managed with limited resources.

Sarcoidosis is a multi-system disorder of unknown aetiology characterised by non-caseating granulomatous inflammation with varying presentation and prognosis. Bone involvement is uncommon and vertebral involvement is rare. We report a case of vertebral osseous sarcoidosis which presented with pulmonary symptoms mimicking tuberculosis and later developed vertebral involvement despite administration of oral corticosteroids.

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Novel data on Multiple Sclerosis (MS) in Pakistan from leading institutes in the country was presented at the first Pakistan Treatment in Multiple Sclerosis (PAKTRIMS) Conference, organized by the section of neurology, department of medicine, Aga Khan University, Karachi on Saturday, December 18, 2021. Pakistan has been considered to have a low prevalence of MS; however, recent research reveals that it is not as uncommon as previously believed to be in the country. The true prevalence and incidence of MS in the country is unknown because of dearth of research. Data of MS patients enrolled in various private and public institutes in Pakistan highlights the current treatment offered in Pakistan for MS patients with steroids as the mainstay treatment and disease modifying drugs (DMD) mainly including azathioprine, ocrelizumab and rituximab. Available data featuring disease progression indicates a successful response to the treatment offered to patients with improved expanded disability status scale (EDSS) and radiological findings. The conference was a steppingstone towards future research in MS in Pakistan as it highlighted what is furthered required to have a better picture of the disease in the country. Available data majorly outlines demographic characteristics and disease characteristics, however, there is a need for research to fill in the gap for data in reporting MS diagnosis, treatment, and disease outcome to develop a better healthcare system geared towards MS patients in a low- and middle-income Country (LMIC)