Diagnosis Of Seizure Disorders Research Articles

Measles to Misfortune: A Case Report on Subacute Sclerosing Panencephalitis

Subacute sclerosing panencephalitis (SSPE) is a progressive neurological disorder of children or young adults caused by measles infection. An abnormal immune response to the virus is said to cause brain inflammation, which may last for years. Mortality rate of the disease is around 95%. In this case report, we present the case of a 15-year-old unimmunized boy from rural Assam who presented with progressive sudden jerky movements of his limbs for 2 months, along with difficulty in doing his daily activities and forgetfulness. Although he was initially admitted with a provisional diagnosis of seizure disorder and treated with tab sodium valproate and tab clobazam, his mother, revealed a history of measles infection at 7 years of age. His Electroencephalogram (EEG) reports and CSF IgG measles antibody findings were suggestive of SSPE. He was immediately started on Tab Isoprinosine at adequate doses, but he later succumbed to his illness within 3 months of the onset of symptoms. Immunization of children with the measles vaccine plays a significant role in averting this deadly condition.

Assessment of basic immunological parameters in children with seizure disorders during acute infection

Introduction and objective: The objective of the study was to assess basic immunological parameters in children presenting with seizure disorders during acute infection. Materials and methods: The study was conducted from 19 January 2017 to 5 December 2020 at the Department of Infectious Diseases and Child Neurology in Poznań, and involved 121 patients aged 5–188 months: 64 with febrile seizures and 11 with generalised epilepsy. The control group comprised 46 patients with delayed psychomotor and intellectual development, pervasive developmental disorders, and neurodeficits. A complete blood count with differential white cell count, inflammatory markers, immunoglobulin classes (IgG, IgA, IgM), and the aetiology of infection were analysed using standard laboratory methods in all the cases. Results: Lower IgG was found in the febrile seizures group, and lower IgA was observed in the simple febrile seizure group compared to the patients after epileptic seizures. Patients with first-time simple febrile seizures showed lower IgG levels than the control group. Patients with generalised epilepsy and human herpesvirus 6 (HHV-6) showed lower IgG than the non-infected subjects. Patients with first-time complex febrile seizures had the lowest lymphocyte count compared to the control group. The lowest neutrophil count and total leukocyte count were found in HHV-6-infected patients with simple febrile seizures compared to the non-infected patients. Conclusions: Monitoring basic haematological parameters and immunoglobulin levels is an effective strategy in the diagnosis of seizure disorders in children. Screening tests provide an initial quantitative assessment of humoral and cellular responses, as well as impaired phagocytosis.

THU391 A Case Of Unrecognized Hypoglycemia Due To Methadone Use In A Non-Diabetes Patient

Abstract Disclosure: D. Owais: None. J.R. Fredrick: None. Y. Jamal: None. S. Sajnani: None. Introduction: Methadone is a rare cause of insulin-mediated hypoglycemia. Hypoglycemia can be manifested as autonomic instability (palpitations and diaphoresis) and neuroglycopenia (agitation and altered mentation). We present the case of hypoglycemia in a non-diabetic patient with no renal insufficiency and who was on a high dose of Methadone. Case: A 76-year-old male with a medical history of HTN, CAD, CVA, dementia, chronic opioid use (on methadone 80 mg) initially presented two times to an outside hospital for intractable seizures. The diagnosis of seizure disorder was made and was discharged on valproate. Per his wife, he had a few low blood sugars during those hospitalizations. Within a month of discharge, he was admitted to another hospital for severe bradycardia and had undergone pacemaker implantation. He was then discharged to nursing home (NH). In the NH, the routine laboratory work showed a serum blood glucose of 42; however, it was interpreted as a lab error. The next day, he developed severe metabolic encephalopathy, intractable seizures and transferred to our hospital. On arrival, serum blood sugar was 59, corrected by 50% of dextrose. His physical examination was significant for a thin-built elderly male, lethargic but in no acute distress. The dose of antiseizure medication was adjusted. The Methadone 80 mg daily was resumed. He continued to have intermittent hypoglycemia to as low as 33 despite being on intravenous (IV) dextrose solutions. His symptoms used to improve temporarily after the correction of hypoglycemia. (Positive Whipple’s triad). Blood cultures and urine cultures were negative. Serum cortisol level, IGF -1, TSH levels, blood pressure, and electrolytes were within normal limits. The hypoglycemia workup performed in a fasting state (off IV dextrose) showed endogenous hyperinsulinism with insulin level >3, C-peptide level >0.2, beta-hydroxybutyrate level of <2.7, and negative sulfonylurea screen. CT scan and ultrasound of the abdomen were performed to rule out insulinoma; however, it demonstrated complete atrophy of the pancreas. Therefore, a high dose of methadone was assumed to cause hypoglycemia, as the patient had no hypoglycemic episodes when he could not receive two doses of methadone due to encephalopathy. The trough levels of methadone in the blood were high at 650 ng/dl. Methadone dose was tapered to 60 mg daily. He was also started on octreotide to manage his hypoglycemia. However, the patient developed severe pneumonia, and family opted for hospice. Conclusion: Our case is unique as the patient was developing severe signs of hypoglycemia, including bradycardia and seizures, and treated with a pacemaker and antiseizure medications. His Methadone-induced hypoglycemia was identified late as the cause of his symptoms. Therefore, it is crucial to recognize this side effect of Methadone in differentials in a patient with hypoglycemia. Presentation: Thursday, June 15, 2023

Adverse Childhood Experiences Are Associated With Seizures in Children: A Cross-sectional Analysis.

To assess the relationship between adverse childhood experiences (ACE/ACEs) and epilepsy. We performed a cross-sectional retrospective cohort analysis using population-based data from the 2018 and 2019 National Survey of Children's Health to examine caregiver-reported ACE exposures and their relationship to caregiver-reported physician diagnoses of epilepsy or seizure disorder in children. ACEs elicited in the survey included questions about experience of violence, household dysfunction, and food and housing insecurity. Adjusting for age, race, and income level, we used logistic regression to test the relationships between cumulative ACE score and current seizure disorder or epilepsy diagnosis and to examine which specific ACEs were individually associated with current seizure disorder or epilepsy diagnosis. The study population consisted of 59,963 participants; 52.2% were female, and 47.8% were male. Participant ages ranged from 0 to 17 years. A current diagnosis of epilepsy or seizure disorder was reported in 377 (0.63%) participants, and 22,749 (37.9%) participants had one or more ACE exposures. As the number of ACEs increased, odds of current epilepsy or seizure disorder diagnosis increased by 1.14 (95% confidence interval 1.07-1.22). Five ACE exposures demonstrated a high association with a current diagnosis of epilepsy or seizure disorder: food/housing insecurity, witnessing domestic violence, household mental illness, neighborhood violence, and parent/guardian incarceration. Multiple ACE exposures were individually associated with reporting a diagnosis of epilepsy or seizure disorder. An increase in cumulative ACE exposures increased odds of having current diagnosis of epilepsy or seizure disorder.

1287 THE VALUE OF A MULTIDISCIPLINARY TEAM (MDT) IN MANAGING PATIENTS WITH COMPLEX OR UNEXPLAINED SYNCOPE

Abstract Introduction Syncope is a common clinical problem with a lifetime prevalence of 20%.1 Syncope shares clinical features with other disorders including seizures, metabolic disturbances and sleep disorders.2 The assessment and management of syncope can be challenging. The syncope service at the QEUH is run by geriatricians and cardiologists with an interest in syncope. Although MDTs are recognised key components in contemporary patient care in areas such as heart failure and cancer management, there is no guidance on MDT working in syncope management.3/4 In November 2017, a syncope MDT was introduced at the QEUH involving cardiologists, geriatricians, a neurologist and cardiac physiologists. This in-person MDT occurs monthly with outcomes recorded on electronic medical records in addition to a database. The aim of this review was to understand the potential impact of the MDT on diagnostic yield and time to further investigation or management. Method A retrospective case note analysis was performed for patients reviewed at the Syncope MDT between November 2017 and December 2021. Results 103 patients were discussed with an average age of 64 years. The main reason for referral was cardiology specialist advice (65%), neurology specialist advice (19.4%) and complex case review (13.6%). After MDT discussion, the percentage of patients with unexplained TLoC reduced from 26.2% to 14.6% without requirement for additional investigations. 8.7% of patients were started on anti-epileptic medication prior to outpatient neurology review after a diagnosis of seizure disorder was established and 23.1% of patients were streamlined for pacemaker or ILR insertion. Conclusion Introduction of a syncope MDT reduces unexplained syncope rates in complex patients, streamlines investigations, reduces the need for multi-speciality outpatient reviews and allows earlier introduction of anti-epileptic medication for those with a new seizure disorder. These benefits improve the patient experience by reducing time to diagnosis and treatment.

Abstract 10047: A Case of Recurrent Miscarriages Due to Malignant Situational Cardioinhibitory Nerurocardiogenic Syncope Treated With Pacemaker Placement

Case Presentation: A 29- year-old G5A4 woman with history of seizure disorder presented with severe nausea and vomiting (N&V) with transient loss of consciousness with twitching motor activity at 7-weeks' gestation. She had no post-ictal state, but a brief period of nausea and lethargy with a rapid return to baseline. Her medical history only included a diagnosis of seizure disorder since childhood treated with different anti-epileptic agents. She reported 4 first-trimester abortions secondary to reported intractable recurrent seizures during pregnancy accompanied by significant morning sickness. Her physical examination, laboratory tests, brain CT, EEG, EKG, and a trans-thoracic echocardiogram were unremarkable. Levetiracetam was started. While monitored in telemetry she had an episode of complete heart block for 8-seconds with ventricular standstill triggered by a bout of severe N&V resulting in convulsive syncope. The diagnosis of situational cardioinhibitory malignant Neurocardiogenic Syncope (NS) was made. She underwent dual-chamber pacemaker implantation with complete resolution of her symptoms. After 6-months Levetiracetam was discontinued. Her pregnancy progressed to term delivering a healthy newborn. She remains asymptomatic 4 years after her pacemaker implantation. Discussion: Malignant NS is a type of neurally-mediated syncope that can lead to significant morbidity and occasional mortality. Situational syncope occurs when a vaso-vagal reflex occurs in response to a specific trigger, in the present case straining is associated with N&V and has not been described with miscarriages. In this case, the pronounced vagal response to N&V resulted in ventricular stand-still causing brain hypoperfusion and seizures, which are associated with miscarriage due to slower fetal heart rate, fetal hypoxia, fetal injury, placental hypoperfusion, placental abruption or trauma. To the best of our knowledge, this is the first case reported in the literature of recurrent miscarriages due to NS successfully treated with a pacemaker. Conclusions: Convulsive syncope can result in miscarriages and should remain in the differential diagnosis in patients presenting with suspected seizures associated with vaso-vagal triggers during pregnancy.

Psycho-socio-clinical profiles and quality of life in seizure disorders: A cross-sectional registry study

ObjectiveThis prospective study aimed at comparing quality of life (QoL) and psycho-socio-clinical profiles between patients with epilepsy, psychogenic nonepileptic seizures (PNES), and syncope. We also intended to identify predictors of QoL in these three seizure disorders. MethodsA total of 245 inpatients (epilepsy n = 182, PNES n = 50, syncope n = 13) from a tertiary epilepsy clinic were included. Information on QoL as well as on psychological, sociodemographic, and clinical profiles was retrieved using questionnaires and medical records. Group comparisons on QoL and psycho-socio-clinical profiles were performed via analyses of variance, chi-square tests, and related post hoc tests. Predictors of QoL in epilepsy and PNES were determined using general linear modeling, which was not possible for syncope due to a small sample size. ResultsPatients with epilepsy, PNES, and syncope reported levels of QoL impairment that did not differ significantly between groups (p = 0.266). However, there were significant group differences regarding sex distribution (p < 0.001), seizure disorder duration (p = 0.004), seizure frequency (p = 0.019), current treatment with antiseizure medications (ASM) (p < 0.001), number of current ASM (p < 0.001), and adverse ASM events (p = 0.019). More depressive symptoms (p = 0.001), more adverse ASM events (p = 0.036), and unemployment (p = 0.046) (in this order) independently predicted a diminished QoL in epilepsy. For PNES, more depressive symptoms were the only independent predictor of lower QoL (p = 0.029). ConclusionsPatients with epilepsy, PNES, and syncope experience similarly diminished QoL and show a general psycho-socio-clinical burden with a specific pattern for each seizure disorder diagnosis. Although clinical aspects play an undisputed role for QoL in epilepsy, the psychosocial aspects and consequences are equally, or for PNES probably even more, meaningful. A comprehensive approach to research and treatment of seizure disorders seems mandatory to increase QoL for these patients. More research on QoL in syncope is needed.

The Role of Serial Follow-up and Sleep Deprivation Methods in Improving Electroencephalography Diagnostic Yield in a Cohort of Omanis Aged 13 Years and Above: A Clinical Audit Study

ABSTRACT The aim of this audit study was to establish the utility of follow-up and sleep-deprived electroencephalography testing to improve the detection of interictal abnormalities in a tertiary referral center in Oman. As part of our ongoing auditing process, a total of 3010 EEGs were included in this study. All EEGs were routinely performed for Omanis aged 13 years and above, who were referred for possible diagnosis of seizure disorders. Each EEG was performed over an average period of 20–30 minutes. Of the 3010 EEGs, there were 553 follow-up and sleep-deprived EEGs, including initial baseline EEG studies which were analyzed for this study. The total progressive yield of serial follow-up EEGs to detect overall EEG changes was 53.5%, distributed as 8.8%, 11.4%, 0%, and 33.3% for the second, third, fourth, and fifth serial EEG studies, respectively. For the sleep deprivation EEG group, the yield was 6.5% for detecting overall EEG changes compared to the initial EEG studies. A limitation in this study was the small sample size in the subsequent follow-up and sleep deprivation EEGs. In conclusion, we found a minimal contribution of serial follow-up and sleep deprivation methods in improving the EEG abnormality detection in our study. National guidelines and an increase in awareness among physicians are required to increase the benefit of these well-established, yet not optimally utilized EEG methods.

Comprehensive Performance Analysis of Classifiers in Diagnosis of Epilepsy

Epilepsy becomes one of the most frequently arising brain disorder, and it is marked by the unexpected occurrence of frequent seizures. In this study, the University of the Boon Database with ictal seizure disorder diagnosis of the epilepsy is classified by making use of the expectation maximization features as dimensionality reduction technique followed by the nonlinear model, namely, Gaussian mixture model, logistic regression, firefly algorithm, and hybrid model such as cuckoo search with Gaussian mixture model and firefly algorithm with the Gaussian mixture model which are the classifiers used for the diagnosis of epilepsy from the electroencephalogram signals. The performance of the classifiers is analyzed based on performance index, sensitivity, specificity, accuracy, mean square error, good detection rate, and error rate. The most promising outcome in this work indicates expectation maximization features are applied as the dimensionality reduction technique and the hybrid model Cuckoo search with the Gaussian mixture model outperforms with classification accuracy of 92.19%, performance index of 81.43%, good detection rate of 83.48%, and with low error rate of 15.62%, among other classifiers.

A longitudinal cohort study of childhood MMR vaccination and seizure disorder among American children

BackgroundMeasles (rubeola) is a highly contagious infectious disease with significant morbidity/mortality. Measles-Mumps-Rubella (MMR) is a live-attenuated vaccine used in the United States (US) to prevent measles. This retrospective longitudinal cohort study evaluated childhood MMR vaccination and the risk of a seizure episode and seizure disorder. MethodsThe Independent Healthcare Research Database (IHRD) composed of records prospectively generated from Florida Medicaid was analyzed using SAS to identify persons continuously enrolled from birth for 120 months. Two cohorts were examined: 23,486 persons received at least one dose of MMR vaccine between 12 and 17 months (vaccinated) and 41,725 persons not receiving a measles-containing vaccine (unvaccinated). The daily incidence rate of an initial seizure episode (ICD-9 code: 780.3x) and seizure disorder (ICD-9 code: 345.xx) following an initial seizure episode diagnoses were examined using Cox proportional hazards ratio (HR) and time-trend models post-MMR vaccination compared to unvaccinated persons and in a self-controlled case-series (SCCS). ResultsThe daily incidence rate of an initial seizure episode diagnosed from 6 to 11 days post-MMR vaccination in comparison to 12 to17 months among unvaccinated persons was significantly increased (unadjusted HR = 5.73, p < 0.0001 and adjusted HR = 5.94, p < 0.0001) in HR models. The daily incidence rate of an eventual seizure disorder diagnosis among those diagnosed with an initial seizure episode from 6 to 11 days post-MMR vaccination was significantly increased (unadjusted HR = 17.7, p < 0.01 and adjusted HR = 17.4, p < 0.01) in comparison to the daily incidence rate of an eventual seizure disorder diagnosis among those diagnosed with an initial seizure episode from 12 to 17 months among unvaccinated persons. Time-trend analyses revealed a significantly increased rate ratio (RR) for an initial seizure episode (RR = 4.64, p < 0.0001) and seizure disorder (RR = 5.51, p < 0.0001) diagnoses. Time-trend SCCS analyses revealed a significantly increased daily incidence rate of an initial seizure episode (RR = 3.80, p < 0.0001) when comparing periods from 6 to 11 days post-MMR vaccination to 49–60 days post-MMR vaccination. The incidence rate of an eventual seizure disorder diagnosis among those with an initial seizure episode diagnosis from 6 to 11 days post-MMR vaccination compared to 49–60 days post-MMR vaccination was significantly increased (RR = 4.15, p < 0.01). ConclusionSeizure episode and seizure disorder are rare consequences of routine childhood MMR vaccination.

Seizure Mimics: Oculogyric Crisis Following Metoclopramide-Video

A 9-year-old girl who experienced a seizure disorder was referred to our hospital by a medical practitioner. She presented with recurrent episodes of upward deviation of eyes with neck pain. She had taken tab metoclopramide 10 mg every 8 hours one day before for gastroenteritis. She was aware but unable to voluntarily control the attacks. On examination, she had sustained conjugate upward and lateral deviation of the eyes (oculogyric crisis), without loss of consciousness ([Fig. 1] [Video 1]). Symptoms disappeared rapidly following administration of IV promethazine 0.5 mg/kg slowly, and she remained well during follow-up 1 week later. Oculogyric crisis (OGC) is characterized by a prolonged involuntary upward deviation of the eyes. These episodes generally last for minutes, but can range from seconds to hours. Etiology includes drug-induced reactions, hereditary and sporadic movement disorders, and focal brain zdlesions. The majority of OGC cases occurred as adverse effects of neuroleptics and antiemetics. OGC usually disappears within 24 to 48 hours of drug withdrawal. Administration of anticholinergics (benztropine) or antihistamines (diphenhydramine) can alleviate OGC within minutes. The incidence of metoclopramide-induced acute dystonias is 0.2% with female preponderance.[1] A systematic review and meta-analysis revealed that the most common adverse effects following metoclopramide in children were extrapyramidal symptoms (9%), diarrhea (6%), and sedation (6%).[2] Ozel et al reported acute dystonic reaction due to metoclopramide in a 20-year-old female, which was misinterpreted as conversion disorder and seizure.[3] Acute dystonic reactions due to metoclopramide can be confused with conversion disorders, seizures and encephalitis.[1] [3] Our patient was also referred to our center by a medical practitioner on account of a presumed diagnosis of seizure disorder.

Influence of a Comorbid Diagnosis of Seizure on 30-Day Readmission Rates Following Hospitalization for an Index Stroke

To examine the association of a comorbid seizure diagnosis with early hospital readmission rates following an index hospitalization for stroke in the United States. Retrospective analysis of the 2014 National Readmission Database. The study population included adult patients (age >18 years old) with stroke, identified using the International Classification of Disease Ninth Revision, Clinical Modification (ICD-9-CM) codes 433.X1, 434.X1, and 436 for ischemic stroke as well as 430, 431, 432.0, 432.1, and 432.9 for hemorrhagic stroke. A subgroup of patients with a secondary discharge diagnosis of seizures was identified using the ICD-9-CM codes 780.39 and 345.X. We computed all-cause 30-day readmission rates for all strokes and by stroke type (ischemic versus hemorrhagic). Finally, we used a multivariable logistic regression model to examine the independent association between seizure and readmission by stroke type. Of 271,148 stroke patients, 6.3% (16,970) had a secondary discharge diagnosis of seizures including 5.0% (11,562) of patients with ischemic stroke and 13.4% (5,409) with hemorrhagic stroke. Overall readmission rate for stroke patients was 11.9% (hemorrhagic stroke: 14.2% versus ischemic strokes: 11.6%). Thirty-day readmission rate was higher in patients with seizures for all strokes (15.6% versus 11.7%, P value <.001), ischemic strokes (15.0% versus11.4%, P value <.001), and hemorrhagic strokes (16.7% versus 13.8%, P value <.001). After adjusting for several patient-specific and healthcare system-specific confounders, hospitalized stroke patients with comorbid seizure diagnosis were more likely than those without seizures to be readmitted within 30 days (OR: 1.20, 95% CI: 1.14-1.25). The presence of a comorbid diagnosis of seizure disorder in a hospitalized stroke patient significantly raises the occurrence of early hospital readmission in the United States.

Seizure Disorders at Madonna University Teaching Hospital; Prevalence, Patterns and Co-Morbidities – A 7 Year Review

Objective: The study was designed to study the prevalence, patterns and comorbidities of seizure disorders among psychiatric clinic attendees at Madonna University Teaching Hospital, Elele, Rivers State, Nigeria, over a 7-year period. Materials and Methods: Case files of all psychiatric patients who attended the psychiatric clinic of Madonna University Teaching Hospital (MUTH) from June 2011 to June 2018 were revived. Records of patients who had a diagnosis of seizure disorder were studied. Results: A total of 2,283 patients attended the psychiatric clinic within the time frame stated. Out of this, 148 were diagnosed with a seizure disorder, hence giving a prevalence of 6.5%. The largest proportions of the subjects were aged 21-30 years (33.1%), female (54.1%), single (71.6%) and had a secondary education (39.9%). Tonic clinic seizure was the most prevalent seizure type (55.4%). Most of the patients had neither medical (70.3%) nor psychiatric co-morbidity (60.8%). Temporal lobe epilepsy had the highest psychiatric co-morbidity (91.7%) and the most common psychiatric co-morbidity was Depression (16.2%). The association between seizure type and psychiatric co-morbidity was statistically significant (χ2=22.388, df=8, p<0.05). Conclusion: Tonic-clonic seizure was the most prevalent seizure type seen but those suffering from temporal lobe epilepsy had the highest rate of psychiatric morbidity. Depression was the most common psychiatric co-morbidity among epileptic patients and seizure patients have the tendency to develop another medical condition as they grow older.

Seizure Management and Determining Potentially Misdiagnosed Seizures in Older Adults

Many older adults taking antiseizure medication have a diagnosis of seizure disorders that are not supported by objective diagnostic evidence. These “seizure disorders” are the result of years of misdiagnosis and a belief that the benefits of medication outweigh the potential for a seizure event. However, as the adverse effects of antiseizure medications increase with age and raise the risk of debilitating injury, re-evaluation of patients should be performed to ensure appropriate management. This article provides a foundation for geriatrics providers to appropriately manage misdiagnosed seizures as well as true seizures in older adults. Specific considerations for professionals working in long-term care are included.

A study on EEG findings: An Experience from a Tertiary Care Center of Nepal

Introduction: The electroencephalography (EEG) is the recording of brain’s spontaneous electrical activity over a period of time (15-20) minutes recorded from multiple electrodes placed on the scalp. It is used in seizure disorder, organicity, and psychiatric conditions. There is a paucity of literature with regard to the application of EEG in various conditions in our setting.Objective: The current study aims to explore the EEG findings of different cases and their associations in various clinical scenarios.Method: It is a retrospective study on the patients who underwent EEG in the EEG room of Department of Psychiatry at Patan Academy of Health Sciences (PAHS), Nepal for a year. Information was obtained from EEG register and reports. Data were analyzed using IBM SPSS version 23. Frequency distribution was studied and Chi Square test was applied for categorical variables. The only continuous variable studied was the age for which mean, median and standard deviation were computed and the suitable statistical tool was applied after normality testing.Result: Of the total 164 patients studied, mean age was 21.93 years and 51.2% were male. The common reason for EEG referral was to rule out seizure disorder (80.5%), requested mostly from the department of Psychiatry. EEG abnormality was seen in 43.3% with EEG diagnosis of generalized epilepsy in 26.21% and slow wave (46.2%) as the most common EEG finding. Abnormal EEG detection rate was almost similar in both the genders and predominant in those with a clinical diagnosis of seizure disorder (47.88%). The EEG abnormality detection rate was significant in those referred from the Department of Psychiatry and Paediatrics.Conclusion: EEG is a relatively inexpensive and non-invasive test for detection of electrical activity in the brain. Though requested for seizure or related disorders, it can also find its place in organic pathology, monitoring treatment response among others.

Maternal depression and child psychopathology among Attendees at a Child Neuropsychiatric Clinic in Abeokuta, Nigeria: a cross sectional study.

BackgroundChildren with recognized, diagnosable mental and neurological disorders are in addition prone to emotional and behavioral problems which transcend their specific diagnostic labels. In accessing care, these children are almost invariably accompanied by caregivers (usually mothers) who may also have mental health problems, notably depression. The relationship between child and maternal psychopathology has however not been sufficiently researched especially in low and middle income countries.MethodsMothers (n = 100) of children receiving care at the Child and Adolescent Clinic of a Neuropsychiatric Hospital in Abeokuta, Nigeria took part in the study. To each consenting mother was administered a sociodemographic questionnaire and the Patient Health Questionnaire, while information regarding their children (n = 100) was obtained using the Strengths and Difficulties Questionnaire. Data analysis was done with the Statistical Package for Social Sciences (SPSS) version 16.ResultsThe mean ages of the mothers and children were 40.4 years (SD 4.7) and 11.6 years (SD 4.1), respectively. Among the children, 63 % had a main diagnosis of seizure disorder. Regardless of main diagnosis, 40 % of all the children had a comorbid diagnosis. Among the mothers, 23 % had major depressive disorder. A quarter (25 %) of the children had abnormal total SDQ scores. A diagnosis of major depressive disorder in mothers was associated with poor total SDQ scores and poor scores in all SDQ domains except the emotional domain for the children. Major depressive disorder among the mothers was associated with not being married (p = 0.004; OR = 0.142, 95 % CI 0.037–0.546) and longer duration of the child’s illness (p = 0.039, OR = 1.165, 95 % CI 1.007–1.346).ConclusionThe study showed notable rates of depressive illness among mothers of children with neuropsychiatric disorders. Marked rates of emotional and behavioral disorders were also found among the children. Associations were found between maternal and child psychopathology. Mothers of children with neuropsychiatric disorders should be screened for depressive illness.

Electroencephalographic findings in patients referred for electroencephalogram in a University Teaching Hospital in Northern Nigeria

Background: Electroencephalogram (EEG) is a valuable investigation for the assessment of patients with seizures and some other neuropsychiatric disorders. The literature is scanty of reports describing its application and usefulness in Nigerian patients. In this study we analyzed the EEG records of a series of patients who were referred with various provisional diagnoses. Materials and Methods: EEG records of the entire 200 consecutive cases referred from various clinics within and outside a tertiary hospital in Northern Nigeria during a 1 year period were analyzed. Information on biodemographic data, clinical description of symptoms and provisional diagnosis made by referring physicians and the EEG diagnosis were obtained from the records. Results: Most of the attendees were aged between 10 years and 29 years (59.5%) and mostly males (63.5%). About 80% of the attendees had received a provisional diagnosis of seizure disorder (generalized and partial). The EEG diagnosis of seizure disorder accounted for 75%, normal EEG record accounted for 21% and organic brain disorder accounted for 4% of all EEG diagnosis. Generalized seizure disorder was the commonest seizure type by EEG diagnosis (50%). There was a significant association between the provisional diagnosis and EEG diagnosis (P < 0.05). Conclusion: Most of the patients referred for the EEG had their reports consistent with clinical suspicion. EEG was found to be a useful tool in the evaluation of seizures and organic brain disorder in our study.

Diagnostic yield of inpatient video-electroencephalographic monitoring: Experience from a Chinese comprehensive epilepsy center

Video-electroencephalographic monitoring (VEEG) is useful in the diagnosis of seizure disorders; however, its diagnostic yield in developing countries is not well known. The current study retrospectively reviewed the charts of 484 consecutive patients who were admitted to our center between July 2012 and September 2013. Of these patients, 298 (61.6%) were admitted for diagnostic clarification and underwent VEEG for a mean duration of 1.3days (range=1–9days). The patients were divided into two groups: those whose diagnosis was changed and those whose diagnosis was not changed as a result of VEEG. A patient with a preadmission diagnosis of epilepsy who was discharged with a diagnosis of nonepileptic events (NEEs) or who was further classified as focal/generalized epilepsy on discharge was included in the “change in diagnosis” group. A patient admitted with an uncertain diagnosis and discharged with a diagnosis of NEEs or epilepsy (including focal epilepsy and generalized epilepsy) was also included in the “change in diagnosis” group. Video-electroencephalographic monitoring recorded typical ictal events (epileptic events or nonepileptic events) in 147 (49.3%) of the patients admitted for diagnostic clarification. In total, 181 (60.7%) patients had a change in diagnosis after VEEG. Among them, 103 (56.9%) patients had a preadmission diagnosis of epilepsy, which was further classified as focal epilepsy (88 patients) or generalized epilepsy (15 patients); the diagnosis of NEEs and epilepsy was clarified in 78 (43.1%) patients. The number of patients diagnosed with NEEs increased from 31 (10.4%) on admission to 88 (29.5%) on discharge. Among all the patients admitted for diagnostic clarification, therapeutic plans were changed for 104 (57.5%) patients. In 117 (39.3%) patients with no diagnostic change, VEEG evaluation provided confirmative diagnostic information in 47 (15.8%) patients and no additional diagnostic information in 70 (23.5%) patients. The study indicates that VEEG is useful in terms of clarifying seizure diagnoses and evaluating seizure frequency. In our cohort study, VEEG of a relatively short mean duration produced a comparable diagnostic yield as that reported in other studies.

Importance of Video Technologies in Seizure Identification – Evidence through a Case Report

Epilepsy is characterized by unprovoked repetitive occurrence of seizures, which are the clinical manifestation of an abnormal cerebral discharge. Seizure semiology is widely variable, in some cases being difficult to identify and diagnose. Especially in non-convulsive seizures, a high grade of suspicion is necessary and description of episodes by patients and witness may be bizarre and misleading. Video recording of seizures could be widely available through portable cameras and may help physicians recognize seizures. We present a case of a patient with an eight years history of non-convulsive seizures that was only diagnosed with epilepsy after self recording a seizure on his phone camera. Through this case we would like to alert the medical community for the usefulness of these widespread portable video technologies in the diagnosis of seizure disorders.

Variations in Pill Appearance of Antiepileptic Drugs and the Risk of Nonadherence

Generic prescription drugs are bioequivalent to brand-name versions but may not have consistent color or shape, which can cause confusion and lead to interruptions in medication use. We sought to determine whether switching among different-appearing antiepileptic drugs (AEDs) is associated with increased rates of medication nonpersistence, which can have serious medical, financial, and social consequences. We designed a nested case-control study of commercially insured patients in the United States who initiated an AED. Cases were patients who became nonpersistent, defined as failure to fill a prescription within 5 days of the elapsed days supplied. Controls had no delay in refilling and were matched by sex, age, number of refills, and the presence of a seizure disorder diagnosis. We evaluated the 2 refills preceding nonpersistence and determined whether pill color and/or shape matched ("concordant") or did not match ("discordant"). We compared the odds of discordance among cases and controls using multivariate conditional logistic regression, adjusting for baseline characteristics, and drug type. We repeated our analysis among patients with a seizure diagnosis. The AEDs dispensed had 37 colors and 4 shapes. A total of 11,472 patients with nonpersistence were linked to 50,050 controls. Color discordance preceded 136 cases (1.20%) but only 480 controls (0.97%) (adjusted odds ratio [OR], 1.27 [95% CI, 1.04-1.55]). Shape discordance preceded 18 cases (0.16%) and 54 controls (0.11%) (OR, 1.47 [95% CI, 0.85-2.54]). Within the seizure disorder diagnosis subgroup, the risk of nonpersistence after changes in pill color was also significantly elevated (OR, 1.53 [95%, CI 1.07-2.18]). Changes in pill color significantly increase the odds of nonpersistence; this may have important clinical implications. Our study supports a reconsideration of current regulatory policy that permits wide variation in the appearance of bioequivalent drugs.