{"title":"Clinicoradiological Evaluation of Newly Diagnosed Epilepsy: A Monocentric Prospective Study from a Tertiary Care Hospital of Eastern India","authors":"P. D, Mallick A. K., M. G., S. M.","doi":"10.1055/s-0039-1694866","DOIUrl":"https://doi.org/10.1055/s-0039-1694866","url":null,"abstract":"","PeriodicalId":38086,"journal":{"name":"International Journal of Epilepsy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1694866","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43490502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Trends of electroencephalogram (EEG) over 24 to 48 hours can help in prognostication in patients. Continuous electroencephalography (cEEG) allows for “real-time” bedside evaluation of cerebral function and can help to monitor patients in intensive care units. Lack of expertise in interpretation of the long-term EEG patterns and controversies in treatment implications have restricted the widespread use of this modality. This review summarizes the indications, techniques, duration, and pitfalls in cEEG monitoring. Compared with routine planned EEG, use of cEEG monitoring increases the sensitivity to detect nonconvulsive seizures (NCS) or nonconvulsive status epilepticus (NCSE) in unresponsive patients with no or subtle clinical signs of seizures. cEEG helps in reducing the overall intensive care unit (ICU) stay by timely detection of possible ischemic or ictal insults, alleviating the need for costlier imaging tests, and by precise drug adjustment in case of SE. However, standardization of the technical terms for wider applicability is needed. Analysis of automated computerized assays in seizure detection and their clinical role and addressing the technical aspects in long-term recordings should be evaluated; cEEG is gaining an important role in the multiparametric neuro-critical care units. Development of defined guidelines for the indications and application of cEEG, technological advances, and ongoing refinements are expected to enhance its utility in clinical practice.
{"title":"Continuous EEG Monitoring in Intensive Care Unit","authors":"A. Patil, S. Vooturi, S. Jayalakshmi","doi":"10.1055/s-0039-1693079","DOIUrl":"https://doi.org/10.1055/s-0039-1693079","url":null,"abstract":"Abstract Trends of electroencephalogram (EEG) over 24 to 48 hours can help in prognostication in patients. Continuous electroencephalography (cEEG) allows for “real-time” bedside evaluation of cerebral function and can help to monitor patients in intensive care units. Lack of expertise in interpretation of the long-term EEG patterns and controversies in treatment implications have restricted the widespread use of this modality. This review summarizes the indications, techniques, duration, and pitfalls in cEEG monitoring. Compared with routine planned EEG, use of cEEG monitoring increases the sensitivity to detect nonconvulsive seizures (NCS) or nonconvulsive status epilepticus (NCSE) in unresponsive patients with no or subtle clinical signs of seizures. cEEG helps in reducing the overall intensive care unit (ICU) stay by timely detection of possible ischemic or ictal insults, alleviating the need for costlier imaging tests, and by precise drug adjustment in case of SE. However, standardization of the technical terms for wider applicability is needed. Analysis of automated computerized assays in seizure detection and their clinical role and addressing the technical aspects in long-term recordings should be evaluated; cEEG is gaining an important role in the multiparametric neuro-critical care units. Development of defined guidelines for the indications and application of cEEG, technological advances, and ongoing refinements are expected to enhance its utility in clinical practice.","PeriodicalId":38086,"journal":{"name":"International Journal of Epilepsy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1693079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41509397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract A 51-year-old man presented with persistent altered sensorium following a seizure. His magnetic resonance imaging (MRI) showed features of focal encephalitis involving the left temporal, parietal, and occipital regions. His electroencephalogram (EEG) showed ongoing epileptiform discharges over the left hemisphere. This article discusses dilemmas in the diagnosis of nonconvulsive status epilepticus in such a case scenario.
{"title":"Teaching Electroencephalography: Persistent Altered Sensorium with Ominous Appearing Electroencephalographic Activity","authors":"D. D'souza, G. Sarma, Elizabeth T.","doi":"10.1055/S-0038-1676560","DOIUrl":"https://doi.org/10.1055/S-0038-1676560","url":null,"abstract":"Abstract A 51-year-old man presented with persistent altered sensorium following a seizure. His magnetic resonance imaging (MRI) showed features of focal encephalitis involving the left temporal, parietal, and occipital regions. His electroencephalogram (EEG) showed ongoing epileptiform discharges over the left hemisphere. This article discusses dilemmas in the diagnosis of nonconvulsive status epilepticus in such a case scenario.","PeriodicalId":38086,"journal":{"name":"International Journal of Epilepsy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/S-0038-1676560","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42101512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
commonest causes for symptomatic epilepsy were hypoxic ischemic insult and CNS infections. Majority of the patients were fully controlled on drugs. Fifty percent patients were controlled on monotherapy, 30% were controlled on two drugs, and 18% patients required more than two drugs. The most common drug used was phe-nytoin followed by phenobarbitone and levetiracetam, sodi-um valproate, and carbamazepine. Noncompliance of the drug was found to be the most common cause of the recurrent episodes of seizures followed by sleep deprivation and fever. The incidence of mental retardation was 12% and behavioral disorder was 22%. Loss of memory was reported in 48% of the patients, which was relatively very high. Conclusion: Preventable causes of epilepsy share a significant portion in the etiology of the disease. Maximum patients can be managed at rural center without sophisticated investigations.
{"title":"Early Onset Seizures in Vacuolating Megalencephalic Leukoencephalopathy with Subcortical Cysts (MLC-Vander Knaap Disease) in a Brahmin Family","authors":"P. Rani, Swapan Gupta, G. Khwaja","doi":"10.1055/s-0039-1694902","DOIUrl":"https://doi.org/10.1055/s-0039-1694902","url":null,"abstract":"commonest causes for symptomatic epilepsy were hypoxic ischemic insult and CNS infections. Majority of the patients were fully controlled on drugs. Fifty percent patients were controlled on monotherapy, 30% were controlled on two drugs, and 18% patients required more than two drugs. The most common drug used was phe-nytoin followed by phenobarbitone and levetiracetam, sodi-um valproate, and carbamazepine. Noncompliance of the drug was found to be the most common cause of the recurrent episodes of seizures followed by sleep deprivation and fever. The incidence of mental retardation was 12% and behavioral disorder was 22%. Loss of memory was reported in 48% of the patients, which was relatively very high. Conclusion: Preventable causes of epilepsy share a significant portion in the etiology of the disease. Maximum patients can be managed at rural center without sophisticated investigations.","PeriodicalId":38086,"journal":{"name":"International Journal of Epilepsy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1694902","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41812311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Study of Cognitive Functions and Neuropsychiatric Comorbidities among Intractable Epilepsy Patients in a Tertiary Care Hospital","authors":"R. Bhoopathy, E. Maheswari, A. Srinivasan","doi":"10.1055/S-0039-1694891","DOIUrl":"https://doi.org/10.1055/S-0039-1694891","url":null,"abstract":"","PeriodicalId":38086,"journal":{"name":"International Journal of Epilepsy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/S-0039-1694891","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46113708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Sharma, V. Sardana, D. Maheshwari, B. Bhushan, Nishtha Jain, Prashant Shringi, R. Bhattiprolu
Abstract Background Epilepsy is still being considered as a social stigma especially in developing countries such as India. This study was conducted to analyze the problems faced by married women with epilepsy in various aspects of personal and social life. Objectives The main purpose of this article is to study the psychosocial problems, drug compliance, clinical course, attitude of in-laws, and effect of epilepsy on pregnancy and its outcome in married women with epilepsy in Indian scenario. Design, Materials, and Methods This is a prospective observational study including 100 patients. Questionnaire-based face-to-face interview of all the patients was conducted. Patients were divided into informed and concealed groups and various attributes and their significance were compared. Statistical analysis was performed using SPSS-20.0 and Microsoft Office Excel software. Results Out of 100 patients, a total of 58 (58%) patients had informed prior to marriage, while 42 (42%) concealed it. Attitude of husband was negative in 33% (14 out of 42) of concealed group and was statistically significant (p = 0.03). Statistically significant adverse marital outcome was observed in concealed group and Muslim community (p = 0.0001). Majority of the patients in both groups (86%) opined that it should be disclosed prior to marriage. Conclusion In a developing country such as India, epilepsy is still considered a social stigma that can manifest as felt or enacted stigma. Previous studies clearly indicate increasing awareness. Social stigma associated with epilepsy can only be eliminated with collaborative efforts of healthcare professional, government, and general public.
{"title":"Problems Faced by Married Women with Epilepsy in Indian Scenario: A Hospital-Based Study","authors":"S. Sharma, V. Sardana, D. Maheshwari, B. Bhushan, Nishtha Jain, Prashant Shringi, R. Bhattiprolu","doi":"10.1055/s-0038-1675688","DOIUrl":"https://doi.org/10.1055/s-0038-1675688","url":null,"abstract":"Abstract Background Epilepsy is still being considered as a social stigma especially in developing countries such as India. This study was conducted to analyze the problems faced by married women with epilepsy in various aspects of personal and social life. Objectives The main purpose of this article is to study the psychosocial problems, drug compliance, clinical course, attitude of in-laws, and effect of epilepsy on pregnancy and its outcome in married women with epilepsy in Indian scenario. Design, Materials, and Methods This is a prospective observational study including 100 patients. Questionnaire-based face-to-face interview of all the patients was conducted. Patients were divided into informed and concealed groups and various attributes and their significance were compared. Statistical analysis was performed using SPSS-20.0 and Microsoft Office Excel software. Results Out of 100 patients, a total of 58 (58%) patients had informed prior to marriage, while 42 (42%) concealed it. Attitude of husband was negative in 33% (14 out of 42) of concealed group and was statistically significant (p = 0.03). Statistically significant adverse marital outcome was observed in concealed group and Muslim community (p = 0.0001). Majority of the patients in both groups (86%) opined that it should be disclosed prior to marriage. Conclusion In a developing country such as India, epilepsy is still considered a social stigma that can manifest as felt or enacted stigma. Previous studies clearly indicate increasing awareness. Social stigma associated with epilepsy can only be eliminated with collaborative efforts of healthcare professional, government, and general public.","PeriodicalId":38086,"journal":{"name":"International Journal of Epilepsy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1675688","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49328748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Karan Chouhan, Ch C Gupta, Archita Chawla, S. Kaushal, Gagandeep Singh, N. Bansal, S. Sharma
{"title":"Impact of Repeated Health Education Delivery on Antiepileptic Drug Adherence in People with Chronic Epilepsy in the Community","authors":"Karan Chouhan, Ch C Gupta, Archita Chawla, S. Kaushal, Gagandeep Singh, N. Bansal, S. Sharma","doi":"10.1055/S-0039-1694879","DOIUrl":"https://doi.org/10.1055/S-0039-1694879","url":null,"abstract":"","PeriodicalId":38086,"journal":{"name":"International Journal of Epilepsy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/S-0039-1694879","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46121144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
in HS patients, providing a rationale for conducting further exploratory studies. Objective: Long-term treatment by antiepileptic drugs (AEDs) is vital for effective control of seizures in patients with epilepsy ( p WE). The present study was per-formed to measure extent and factors influencing adherence to AEDs. Methods: The present study was a prospective, cross-sectional study, involving PWE reporting at a tertiary care hospital. The extent of adherence to AEDs was mea-sured using Morisky Medication Adherence Scale (MMAS). Data from 451 patients with confirmed diagnosis of epilepsy were subjected to univariate analysis using Chi-square test to observe association between AED adherence and different variables. Further the predictors of adherence were analyzed using binary regression analysis. Results: There were 251 (55.7%) male and 198 (43.9%) female PWE. The extent of adherence to AEDs was high among 326 (72.3%) and low in 125 (27.7%). The socioeconomic status ( p = 0.043) and type of epilepsy ( p = 0.033) were found to be significantly associated with AED adherence. However, no significant difference was observed between adherence and age, gender, marital status, epilepsy duration, number, and type of AEDs, and occurrence of ad-verse drug reactions. Patients with focal epilepsy and those from the middle/lower to middle socioeconomic classes were less likely to be nonadherent. The primary reason for nonad-herence was forgetfulness. Conclusion: Forgetfulness was a primary preven-tive factor for AED nonadherence. We recommend methods to improve the same using multiple measures to maximize adherence and minimize development of pharmaco-resis-tance to AEDs To evaluate the anticonvulsant properties in albino rats by pentylenetetrazole ( p TZ) model. generalized seizures. Magnetic resonance imaging (MRI) was abnormal in 53.6% of cases. Granuloma-tous lesion was dominant neuroimaging finding in our study. Conclusion: This study concluded that males of second and third decades from rural Background are highly prone to epilepsy. Infectious causes like neurocysticercosis and tu-berculoma are predominant etiologies in our area. Neuroimaging plays an important role in establishing and localizing etiology of seizure. Any patient coming with history of epilepsy or suspected as a case of newly diagnosed epilepsy must be investigated with neuroimaging for further management.
{"title":"An Evaluation of Factors Influencing Adherence to Antiepileptic Medications (AEDs): A Cross-sectional Hospital-Based Study—An Overview and Recommendations to Improve","authors":"C. Kulkarni, Ranjana G., G. Sarma","doi":"10.1055/S-0039-1694862","DOIUrl":"https://doi.org/10.1055/S-0039-1694862","url":null,"abstract":"in HS patients, providing a rationale for conducting further exploratory studies. Objective: Long-term treatment by antiepileptic drugs (AEDs) is vital for effective control of seizures in patients with epilepsy ( p WE). The present study was per-formed to measure extent and factors influencing adherence to AEDs. Methods: The present study was a prospective, cross-sectional study, involving PWE reporting at a tertiary care hospital. The extent of adherence to AEDs was mea-sured using Morisky Medication Adherence Scale (MMAS). Data from 451 patients with confirmed diagnosis of epilepsy were subjected to univariate analysis using Chi-square test to observe association between AED adherence and different variables. Further the predictors of adherence were analyzed using binary regression analysis. Results: There were 251 (55.7%) male and 198 (43.9%) female PWE. The extent of adherence to AEDs was high among 326 (72.3%) and low in 125 (27.7%). The socioeconomic status ( p = 0.043) and type of epilepsy ( p = 0.033) were found to be significantly associated with AED adherence. However, no significant difference was observed between adherence and age, gender, marital status, epilepsy duration, number, and type of AEDs, and occurrence of ad-verse drug reactions. Patients with focal epilepsy and those from the middle/lower to middle socioeconomic classes were less likely to be nonadherent. The primary reason for nonad-herence was forgetfulness. Conclusion: Forgetfulness was a primary preven-tive factor for AED nonadherence. We recommend methods to improve the same using multiple measures to maximize adherence and minimize development of pharmaco-resis-tance to AEDs To evaluate the anticonvulsant properties in albino rats by pentylenetetrazole ( p TZ) model. generalized seizures. Magnetic resonance imaging (MRI) was abnormal in 53.6% of cases. Granuloma-tous lesion was dominant neuroimaging finding in our study. Conclusion: This study concluded that males of second and third decades from rural Background are highly prone to epilepsy. Infectious causes like neurocysticercosis and tu-berculoma are predominant etiologies in our area. Neuroimaging plays an important role in establishing and localizing etiology of seizure. Any patient coming with history of epilepsy or suspected as a case of newly diagnosed epilepsy must be investigated with neuroimaging for further management.","PeriodicalId":38086,"journal":{"name":"International Journal of Epilepsy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/S-0039-1694862","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42060823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Bajaj, P. Chandra, B. Ramanujam, Shabari Girishan, R. Doddamani, M. Tripathi
and the neurologist made final diagnosis. For further confirmation, CT scan/MRI head and EEG recording of all patient were done. Results: The age of all five cases varied from 12 to 45 years and out of five, two were females; they belonged to lower socioeconomic status and were educated. Two patients had positive family history of epilepsy but their siblings did not have similar complaints. All five patients have initial agitation followed by wandering aimlessly for varied durations. Findings of CT scan, laboratory investigations were normal but EEG in all five patients was abnormal. Conclusion: The fugue stages in psychological dis-order differ from patients with epilepsy/organic causes of fugue, in dissociative fugue, there are temporal relation found with psychological trauma. In those phases, patient maintains his safety with different identity and the initial symptom of abnormal behavior unlikely occurs. We found in these cases that patients were not able to maintain them-selves during fugue stage and their initial presentations were agitation and the important differences were found in EEG reports, those were abnormal.
{"title":"Hemispherotomy in Adults. Is It Safe?—A Prospective Observational Study in Comparison to Children","authors":"J. Bajaj, P. Chandra, B. Ramanujam, Shabari Girishan, R. Doddamani, M. Tripathi","doi":"10.1055/S-0039-1694874","DOIUrl":"https://doi.org/10.1055/S-0039-1694874","url":null,"abstract":"and the neurologist made final diagnosis. For further confirmation, CT scan/MRI head and EEG recording of all patient were done. Results: The age of all five cases varied from 12 to 45 years and out of five, two were females; they belonged to lower socioeconomic status and were educated. Two patients had positive family history of epilepsy but their siblings did not have similar complaints. All five patients have initial agitation followed by wandering aimlessly for varied durations. Findings of CT scan, laboratory investigations were normal but EEG in all five patients was abnormal. Conclusion: The fugue stages in psychological dis-order differ from patients with epilepsy/organic causes of fugue, in dissociative fugue, there are temporal relation found with psychological trauma. In those phases, patient maintains his safety with different identity and the initial symptom of abnormal behavior unlikely occurs. We found in these cases that patients were not able to maintain them-selves during fugue stage and their initial presentations were agitation and the important differences were found in EEG reports, those were abnormal.","PeriodicalId":38086,"journal":{"name":"International Journal of Epilepsy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/S-0039-1694874","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44291935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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