Seizure Episodes Research Articles

The Outcome of Status Epilepticus Among Adults in Aseer Region of Saudi Arabia

IntroductionEpileptic seizure episodes can vary from brief and nearly undetectable to long periods of vigorous shaking. These episodes can result in physical injuries, occasionally including broken bones. With epilepsy, seizures tend to recur and, as a rule, have no immediate underlying cause. Status epilepticus (SE) is an attack of a seizure lasting for more than five minutes or two or more seizures without the person returning to normal between the attacks. Previous definitions used a 30-minute time limit. This study aimed to assess the clinical outcome of SE among adult patients in the Aseer region.Materials and methodsA retrospective record-based cohort study design was conducted, targeting all accessible medical files of adult patients with SE who were admitted to the Aseer central hospital and military hospital from 2010 to 2017. Data were extracted from all complete and accessible files. Records with missing data were excluded. Clinical outcomes for the cases included were assessed and categorized into cases of complete recovery (without sequelae), cases with incomplete recovery, and death.ResultsThe study included 19 adult patients with SE whose ages ranged from seven to 87 years with a mean age of 33.4 ± 22.5 years. Men made up 63.2% of the cases. Infection was the most recorded risk factor among the cases, followed by anti-epileptic drug withdrawal. Only two cases recovered with sequelae, while the remaining 17 cases recovered completely. There were no deaths.ConclusionsThe study revealed that nearly all cases recovered completely with no complications, particularly men who immediately received IV treatment. Early diagnosis and receiving treatment under careful observation via follow-up are recommended.

Clinical characteristics and electroencephalographic findings of first seizure episode in children

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

A new phenotype of aldolase a deficiency in a 14 year-old boy with epilepsy and rhabdomyolysis \u2013 case report

BackgroundGlycogen storage disease type XII is a rare metabolic disease resulting from Aldolase A deficiency that causes muscle glycogen accumulation, with crisis of rhabdomyolysis and hemolytic anemia. In the very few cases described, rhabdomyolysis crises are caused by fever and/or exercise and can accompany acute hemolytic anemia. Although currently there is no therapy available for this disease, the guidelines for the management of other forms of glycogen storage diseases recommend a nutritional therapy in order to avoid hypoglycemia or prevent exercise-induced rhabdomyolysis.Case presentationIn this case report we describe a new phenotype of the disease in a 14-year-old boy, characterized by seizures and rhabdomyolysis. Beside an antiepileptic treatment, we propose a new therapeutic approach based on ketogenic diet in order to supply an energetic substrate for skeletal muscle and neurons.ConclusionsThe anti-epileptic therapy and the dietetic approach were well tolerated by the patient who showed good compliance. This led to a deceleration of the disease with no other acute episodes of seizures and rhabdomyolysis, without any side effects observed.

Case of Insulinoma in a 2-Months-Old Infant

INTRODUCTION: Insulinoma is congenital hyperinsulinism of infancy (CHI). It is a type of functional neuroendocrine tumor (NET) in the pancreas that manifests with persistent hypoglycemia caused by inappropriately high secretion of insulin (hyperinsulinemia). Comprehensive and multidisciplinary management is required for a better outcome. CASE PRESENTATION: A 2-months-old girl came to the Emergency unit Sanglah Hospital, with a chief complaint of seizure. The patient had a low blood glucose level, high fasting insulin, high LDH, computed tomography of the abdomen result showed isodense heterogeneous lesions border in the cauda pancreas with size 1.32 × 1.24 × 1.35 cm. The anatomy-pathological result showed pancreatic neuroendocrine tumor WHO Grade II, functional, consistent, and clinically to insulinoma on the tail of the pancreas. The patient was treated with hydrocortisone, nifedipine, and octreotide. The patient underwent laparotomy partial pancreatectomy. In post-surgery condition, she had good drink tolerance, no episode of recurrent seizure, and blood glucose was controlled. CONCLUSION: Insulinoma is a rare disease. The diagnosis was challenging. This case report presents the diagnostic work-up and management of a patient with a persistent hypoglycemia condition that was diagnosed as insulinoma.

The Frequency of Clinical Seizures in Paroxysmal Events in a Neonatal Intensive Care Unit.

Background: In general clinical practice, neonatal seizures are identified visually by direct clinical observation. The study aimed to examine the frequency of clinical seizures in paroxysmal events in a neonatal intensive care unit. Methods: We conducted a prospective study of continuous video-EEG monitoring in a neonatal intensive care unit between January 2017 and December 2020. The demographic data were also reviewed. Results: Sixty-four neonates were enrolled. The median total video-EEG monitoring duration was 24.1 h (IQR 17.5–44.8 h). There were 309 clinically suspected seizure episodes, of which 181 (58.6%) were the motor type and 128 (41.4%) were the non-motor type. Only 63 (20.4%) of these events were confirmed to be clinical seizures on a simultaneous video-EEG recording. In terms of the impact of continuous video-EEG monitoring on clinical management, the anti-epileptic drugs were changed in 42 (65.6%) of the 64 neonates. Conclusion: In the identification of neonatal seizures, a clinical diagnosis by direct observation alone is not enough. The use of continuous video-EEG monitoring plays an important role in the diagnosis of neonatal seizures and in guiding clinical management decisions.

Alcohol Induced Cerebellar Ataxia: A Case Report

<p style="text-align: justify;">Consumption of alcohol excessively causes dependence and leads to psychological discomfort. Motivation to drink is influenced by a variety of neurobiological and environmental variables. The proclivity of an individual to imbibe is thought to reflect a balance between alcohol&rsquo;s positive reinforcing (i.e., rewarding) effects, such as euphoria and anxiety reduction (i.e., anxiolysis), and the drug&rsquo;s aversive effects, which are typically associated with negative consequences of alcohol consumption (e.g., hangover or withdrawal symptoms). Neuroadaptive alterations caused by continuous alcohol use and abuse (such as tolerance and physiological dependence) are regarded to be critical in the shift from regulated alcohol use to more frequent and excessive, uncontrollable drinking which induces cerebellar degeneration considered as common type of acquired toxic ataxia. Excessive use leads to degeneration of the midline cerebellum. Progressive trunk and gait ataxia is characteristic, with little involvement of upper limbs, eyes or speech (a corollary of relative cerebellar hemispheric sparing). Abrupt termination of alcohol use after a period of heavy drinking may result in alcohol withdrawal seizures. Generalized tonic&ndash;clonic seizures are the most common and severe form of seizure in this conditions. Current case report presents complaints of astasia and slurred speech with few episodes of seizures. The diagnosis indicated Mild cerebellar atrophy. Patient was advised to undergo de-addiction and cure. <p style="text-align: justify;"><strong>Key words:</strong> Cerebellar ataxia, Alcohol, Cerebellar atrophy, GABA, astasia,seizures.

D-Cycloserine-Induced Seizure Activity in the Emergency Department: A Case Report

D-cycloserine (DCS) is an anti-tuberculosis medication that has been utilized for years for drug-resistant tuberculosis. DCS works via a centrally acting mechanism which can cause neurotoxic adverse effects which has limited its use. This centrally acting mechanism also allows for DCS to be utilized for various neuropsychiatric purposes. Our patient was on high-dose DCS for autism spectrum disorder and presented to the emergency department (ED) with a seizure. The seizure episode was managed with both anti-epileptics and pyridoxine. With increasing novel use of this older medication, it is imperative for ED clinicians to be aware of the different management strategies that may be required when a patient presents with a neurotoxic effect, specifically seizures, secondary to DCS.

Congenital Adrenal Hyperplasia, a mimicry of neonatal sepsis

Background&#x0D; Neonatal sepsis is one of the commonest reasons for admission to the neonatal unit. Its non-specific clinical features makes its definition a conundrum for experts. This paves way for several conditions to hide behind the umbrella of neonatal sepsis. One of such conditions is salt-wasting crisis in babies with Congenital Adrenal Hyperplasia. The objective of this abstract is to highlight the importance of a good clinical history, thorough physical examination and investigations to avoid incorrect diagnosis and management of babies with adrenal crisis.&#x0D; Clinical presentation&#x0D; A month-old infant presented with poor feeding, vomiting, fever and seizures. Physical examination revealed high temperature of 38.2 degree Celsius, signs of dehydration, episodes of seizures and lethargy.&#x0D; A diagnosis of neonatal sepsis with differential of neonatal meningitis was made. Empiric antibiotics and supportive therapy with intravenous infusions and anticonvulsants were started. After 24 hours, there was deterioration in baby’s presentation with spiking temperature and progressive lethargy requiring escalation of care. This prompted further history and examination.&#x0D; Baby had a notably hyperpigmented skin and ambiguous genitalia. The external genitalia was a phallus-like/large clitoris-like structure measuring 1.8cm in length. Urethral meatus was at the base of the phallus – like structure. The sac-like folds in the perineum were fused with no vaginal opening or palpable testes.&#x0D; Biochemical investigations showed hyponatremia (Na-121umol/l), hyperkalaemia(K-6.4umol/l) and 17-hydroxyprogesterone of 1057.5nmol/l (&lt; 18.9nmol/l).&#x0D; The diagnosis was revised to Congenital Adrenal Hyperplasia with salt wasting crisis. The baby underwent aggressive electrolyte correction and was started on high dose steroids. There was remarkable improvement in baby’s condition and was discharged after five days.&#x0D; Conclusion&#x0D; Several conditions can mimic neonatal sepsis therefore the importance of a detailed history and thorough physical examination cannot be over-emphasized.

Approach to an adult with an episode of seizure

A patient with known epilepsy who has had a single, habitual seizure and whose mental status has returned to baseline need not be transported to the emergency department (ED) unless other injuries require so, whereas a patient with no history of epilepsy who has returned to baseline following a seizure should be evaluated. The evaluation should include basic biochemical parameters, toxicology screening and a brain imaging. One should investigate circumstances that may have precipitated a seizure, such as alcohol withdrawal, stimulant use, or head injury. Risk of recurrence of seizures is more likely in those with a history of significant brain injury or infection. If the patient has a normal magnetic resonance imaging (MRI) and electroencephalograph (EEG), the likelihood of a second seizure is approximately 1 in 3; if either test result is abnormal, the chances are approximately 1 in 2; if both are abnormal, the probability rises to 2 in 3. Computed tomography (CT) scan head is very useful in the evaluation of first seizure in infants less than six months of age. The clinical characteristics predictive of an abnormal CT scan for patients presenting with seizures were age less than 6 months or age greater than 65 years, history of cysticercosis, altered mentation, closed head injury, recent cerebrospinal fluid (CSF) shunt revision, malignancy, neurocutaneous disorder and seizures with focal onset or duration longer than 15 minutes. MRI has been shown to be superior to CT for the detection of cerebral lesions associated with epilepsy.

Is It Time to Test the Antiseizure Potential of Palmitoylethanolamide in Human Studies? A Systematic Review of Preclinical Evidence.

Antiseizure medications are the cornerstone pharmacotherapy for epilepsy. They are not devoid of side effects. In search for better-tolerated antiseizure agents, cannabinoid compounds and other N-acylethanolamines not directly binding cannabinoid receptors have drawn significant attention. Among these, palmitoylethanolamide (PEA) has shown neuroprotective, anti-inflammatory, and analgesic properties. All studies examining PEA’s role in epilepsy and acute seizures were systematically reviewed. Preclinical studies indicated a systematically reduced PEA tone accompanied by alterations of endocannabinoid levels. PEA supplementation reduced seizure frequency and severity in animal models of epilepsy and acute seizures, in some cases, similarly to available antiseizure medications but with a better safety profile. The peripheral-brain immune system seemed to be more effectively modulated by subchronic pretreatment with PEA, with positive consequences in terms of better responding to subsequent epileptogenic insults. PEA treatment restored the endocannabinoid level changes that occur in a seizure episode, with potential preventive implications in terms of neural damage. Neurobiological mechanisms for PEA antiseizure effect seemed to include the activation of the endocannabinoid system and the modulation of neuroinflammation and excitotoxicity. Although no human study was identified, there is ground for testing the antiseizure potential of PEA and its safety profile in human studies of epilepsy.

A Case Study of Oxcarbazepine-induced Stevens-johnson Syndrome

Background: Stevens–Johnson syndrome is a rare potentially fatal disorder characterized by mucosal membrane erosions, bullous skin lesions and epidermal detachment.&#x0D; Objective: This case report discusses a case of a patient who developed seizures and macular rashes as a result of Stevens–Johnson syndrome induced by oxcarbazepine.&#x0D; Case presentation: An eight-year-old girl was admitted to hospital with complaints of seizure episodes that occurred during sleep, characterized by drooling, jerky stiff upper limbs, throat sounds, and blue lips. Patient was born with severe intrauterine growth retardation and microcephaly and was diagnosed with congenital cytomegalovirus (CMV). EEG results confirmed that focal epilepsy was the underlying cause of seizures. The patient was given oxcarbazepine as an anticonvulsant medication after confirming epilepsy diagnosis. However, after two weeks of treatment, patient developed rashes and skin lesions all over her body except hands. These skin lesions and rashes were red and tan in color, swollen, itchy, scaly, dry, popular, macular and patchy. The skin detachment was less than 10% of BSA (body surface area). The Naranjo algorithm was used to check the probability of a drug reaction and through the WHO-UMC criteria for causality, it was decided that oxcarbazepine induced the syndrome. Hence, patient was diagnosed as a case of Stevens-Johnson syndrome.&#x0D; Conclusion:Stevens–Johnson syndrome is a rare condition that can cause rashes and epidermal detachment. It can be caused by adverse effects of medications; however, exact pathogenesis is unknown. Therefore, studies on large number of patients are required to understand the pathogenesis of oxcarbazepine-induced SJS.

Clinico Etiological Profile of “First Seizure” in Children. Experience from an Armed Forces Tertiary Care Hospital in Eastern India

Introduction: Seizure in the pediatric group is one of the most common emergencies encountered. The aim of this study was the evaluation of the etiology of a first episode of seizure in children so as to assess the short term as well as long-term prognosis. Materials and Methods: We evaluated 86 children 2 months − 12 years presenting to the emergency/outpatient department with the first episode of seizure. Children were further sub-grouped into two age groups of 2 months − 5 years (n = 60) and 5–12 years (n = 26) and acute symptomatic versus unprovoked seizures. Variables assessed were demographics, seizure semiology, laboratory tests, neuroimaging, and outcome at discharge. Results: 69.7% and 30.2% of children were in the age group 2 months to 5 years and 5–12 years, respectively. The mean age of the children was 4.11 ± 3.44 years. 45.3% of cases of acute symptomatic seizures and 54.6% of cases of unprovoked seizures were observed. Acute symptomatic seizures predominated in 2 months − 5 years (60%) while unprovoked seizures predominated in 5–12 years (88.4%). Focal seizures were predominant in the older age group (46.1%) as compared to the younger age group. About 10.4% of cases of seizures first presented as status epilepticus. The most common etiology identified was febrile seizures (27.9%) followed by central nervous system (CNS) structural lesions (19.7%) and CNS infections (10.4%). CSF was done in 18.6% of patients out of which 56.25% samples were positive for CNS infections. 68.6% of children underwent neuroimaging and abnormalities were reported in 67.7% of cases. About 18.6% of children had focal neurological deficits at discharge. Mortality in the entire cohort was 2.3% with 1 child in each vascular and CNS infections group. Conclusions: Children with a first episode of seizure should be evaluated for co-existence of fever, preexisting developmental delays, other associated symptomatology, head trauma, and seizure semiology. Investigations should be done based on a detailed history and clinical examination. Despite a meticulous approach allowing identification of etiology of the first episode of seizure in children, it is possible that no etiology be identified in a substantial number of children, especially in the older age group.

Abstract- Poster

Disulfuram is a widely used drug in treatment of Alcohol dependence syndrome. Extensive literature review shows only a couple of cases that were reported where patients have presented with seizures, following acute use of Disulfuram, which is considered as a rare side effect of Disulfuram.We hereby, report a case of a 28 year old male who presented to casualty with an episode of seizure after starting treatment with Disulfuram. On detailed evaluation, history is suggestive of Alcohol Dependence Syndrome, with multiple past failed de-addiction treatments. Recent admission was a month ago, where patient was admitted for 25 days in a psychiatric setup. At time of discharge, was put of T. Disulfuram 250mg OD. After 7 days of treatment with Disulfuram, he presented with episode of seizure which was acutely managed with benzodiazepine. No other physical comorbidities were reported, CNS examination showed no focal neurological deficits. Blood investigations and Neuroimaging were done to rule out metabolic causes/organicity. All the tests results revealed to be within normal limits.Patient was kept under observation for 48 hrs and later was advised to stop Disulfuram at the time of discharge. Family members were asked to be watchful about any such further episodes.

A rare case of partially empty sella with epileptiform discharges presenting with first episode of mania.

Sir, Busch described the condition empty sella syndrome (ESS) in 1951 where the sella turcica is filled with cerebrospinal fluid (CSF) causing displacement or flattening of the normal pituitary gland.[1] It is reported to occur in 5.5%–23.5% of the population[2] which is pathophysiologically characterized by either anatomic abnormalities in the diaphragma sellae (primary ESS) or damage to the pituitary by irradiation/surgery, or autoimmunity leading to the availability of “empty” space in the sella (secondary ESS).[1] The common signs and symptoms includes headache, papilledema due to raised intracranial pressure, leakage of CSF through nose and weight gain.[1] It can also present as decreased libido, galactorrhea, amenorrhea and secondary infertility.[3] Psychiatric manifestations of ESS are rare but can occur in the form of behavioral disturbances and psychotic symptoms.[4,5] A 25-year-old male presented to us with violent behavior towards family members, reduced need for sleep, elevated self-esteem and grandiose delusions claiming himself to be the prime minister of India. It was associated with one episode of tonic–clonic movements two nights back, with urinary incontinence. Patient also complained of jerky movements in his left arm occasionally about two to three times a day following this. All the symptoms started abruptly for past 10 days, this being his first such episode in his lifetime. There was no history of any febrile illness, head injury, substance abuse; blood parameters that included serum electrolytes, serum prolactin, vitamin B12 levels, and serum osmolality were all within normal limit. He was diagnosed to be in mania as per Diagnostic and Statistical Manual of Mental Disorders (DSM 5). Young’s Mania Rating Scale (YMRS) score was 24. The patient was subjected to magnetic resonance imaging (MRI) scan which revealed empty sella [Figure 1]. 10–20 electroencephalogram findings revealed generalized periodic epileptiform discharges (GPED). The patient was placed on sodium valproate 1000mg, haloperidol 10 mg and trihexyphenidyl 4 mg in divided dosages. The symptoms reduced in severity and YMRS score came 12 on day 5 of admission and EEG was normal. This was his first episode of mania that coexisted with first lifetime episode of seizure. GPEDs results in kindling of neuronal pathways, leading to psychiatric manifestations such as mania. Lateral hypothalamic kindling can induce manic-like behavior in a rat model.[5]Figure 1: MRI scan showing empty sellaThere are reports of atypical presentations of ESS in the form of acute psychosis, sinus bradycardia, herniation of anterior cerebral artery.[5–7] The presentation of empty sella as seizure episode has been reported rarely.[8] Moreover, it is even more rare to be presenting with both seizure episode and mania.[9] In one case report mania was precipitated by hyponatremia in a patient with ESS[10] whereas in our case sodium and other electrolytes level were in normal range. The possible mechanism of such is still a gray area.[9] Even there is also a dilemma of seizure precipitating mania or vice-versa. More sample based studies is needed to establish the neurochemical events leading to the same for better diagnosis and management. Ethical concerns Proper consent was taken from the patient regarding publication of the case without revealing patient’s identity Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Cochlear Implantation in a Case of Jervell and Lange-Nielsen Syndrome Presenting with Absence Seizure and Anemia

Here, we describe the case of a pediatric patient who presented with an episode of absence seizures and was later diagnosed to have Jervell and Lange-Nielsen syndrome (JLNS) and underwent cochlear implantation (CI). A 4-year-old male child born out of a third degree consanguineous marriage presented with congenital profound sensorineural hearing loss and an episode of absence seizures. Electrocardiogram showed a prolonged QT interval of 509 ms. The patient subsequently underwent CI. Here, we outline the challenges anticipated and the precautions to be taken when performing implantation on a patient with JLNS. JLNS is a rare autosomal recessive form of congenital long QT syndrome associated with congenital sensorineural deafness and a high incidence of sudden cardiac death in childhood. Patients with JLNS face added intra- and postoperative challenges during CI which require multidisciplinary and intensive care unit care.

Early Neurodevelopmental Outcome of Asphyxiated Newborns Treated with Therapeutic Hypothermia: A Non Randomised Cohort Study

Introduction: Therapeutic Hypothermia (TH) is now a proven model of treatment to prevent complications in asphyxiated newborns. Perinatal asphyxia is the leading cause of mortality and disability in India and developing countries. The TH is still not the standard treatment protocol in developing India, and data regarding early neurological outcomes after TH is lacking. Aim: To evaluate the early neurological outcome at 3, 6, and 9 months of asphyxiated newborns who received TH compared to non recipients. Materials and Methods: This was a non randomised cohort study conducted at the tertiary care teaching hospital. A total of 190 asphyxiated newborns admitted to Neonatal Intensive Care Unit (NICU) within 24 hours of life, meeting the laboratory and/ or clinical criteria of perinatal asphyxia were enrolled. Eligible newborns admitted within 6 hours of birth receiving TH were labelled as recipients, and those who received standard care were labelled as non-recipients. Neonates were assessed at 3, 6, and 9 months and compared for neurodevelopment using the Hammersmith Infant Neurological Examination (HINE) optimality score and Denver Developmental Screening Test II. Both groups were compared using t-test and chi-square test. Results: Out of the total 190 enrolled participants, 14 were excluded and 176 newborns were further divided into recipients and non recipients groups. Baseline demographic characters were similar in both groups. Seventy-five recipients were followed up till three months, 72 at six months, and 69 at nine months vs 62, 60, and 56 non recipients, respectively. Lesser number of recipients scored suboptimal scores (HINE score &lt;67) at 3 months vs non recipients (20% vs 35.4%, mean/ SD 63 [3.43] vs 57 [4.55], [p&lt;0.001]). At six months (HINE score&lt;70), the incidence was 18% vs 21% (p=0.02), mean score 67 vs 61 (p&lt;0.0001); and at 9 months (HINE score&lt;73) the incidence was 14.4% vs 30.3% (p=0.048), mean score 72 vs 65 among recipient vs non recipients (p&lt;0.0001). Recipients also had less incidence of severe disability (HINE score&lt; 40) at 6 (8.3%vs 21.6% p&lt;0.02), and 9 months (8.3% vs. 19.6%, p&lt;0.04) as compared to non recipients. More recipients had a normal developmental screening at 3,6, and 9 months on the DDST scale. Recipients required fewer anti-epileptics at 3 and 6 months (3 vs 11) as compared to non recipients (p&lt;0.05). Mortality was also less in recipients (7.8% vs 20.9%, p&lt;0.05) as compared to non recipients. Conclusion: There was a significant developmental and neurological improvement with decreased mortality, less episode of seizures, reduction in the need for antiepileptic among recipients of TH compared to non recipients at 3, 6, and 9 months of age.

Unilateral Perisylvian Syndrome with Subcortical Heterotopia: A Case Report

Perisylvian syndrome is a neurological disorder in which a specific area of the brain (called the perisylvian area) develops abnormally, with polymicrogyria as the underlying developmental abnormality. A 21-year-old female reported to the department with complaint of two episodes of seizures per day since 6 months. Magnetic Resonance Imaging (MRI) revealed multiple small gyri with few sulci noted in the right perisylvian cortex and right frontal lobe, suggesting polymicrogyria. Mild volume loss of right frontoparietal lobes was seen. The small subcortical focus of grey matter signal was noted in the right frontal lobe suggesting of heterotopia. The diagnosis of the perisylvian syndrome is mainly based on the clinical and radiologic features which are treated symptomatically and by multidisciplinary rehabilitative measures as there is no cure for this syndrome.

Treatment outcome and associated factors among epileptic patients at ambulatory clinic of Mettu Karl Comprehensive Specialized Hospital: A cross-sectional study.

Objective:The study was aimed to assess the magnitude and associated factors of 2-year seizure-free status of epileptic patients at Mettu Karl Comprehensive Specialized Hospital (MKCSH).Methods:A retrospective cross-sectional study was conducted at MKCSH from 12 February 2020 to 11 August 2020. Treatment outcome was measured in terms of seizure control status and seizure frequency. Accordingly, good treatment outcome was declared if the patients had a 2-year seizure-free status and poor if the patient had episodes of seizure in the last 2 years. The pharmaceutical care network Europe guideline was used to assess the presence of medication-related problems. Multivariable logistic regression was used to analyze the variables by using crude odds ratio (COR) and adjusted odds ratio (AOR) with 95% confidence interval (CI). Finally, the predictors of epilepsy treatment outcome were declared if a P-value was ⩽0.05.Results:Over the study period, more than half of the participants (172 (57.7%)) were males. The median age of participants was 29 and majorly distributed to 18–30 classes. More than one-fourth of the patients were suffering from absent seizure 85 (28.5%) and general tonic-clonic seizure 83 (27.9%). The most commonly prescribed medication was Phenobarbitone which accounts 34 (11.41%), whereas Valproic acid 8 (2.68%) was the least prescribed. Overall, less than half 131 (43.96%) of patients developed poor treatment outcomes. The predictors of treatment outcomes were having head the injury (AOR = 5.7; 95% CI: 3.18, 10.31), family history of epilepsy (AOR = 5.6; 95% CI: 3.07, 10.46) and the presence of drug therapy problems (AOR = 5.2; 95% CI: 2.79, 9.69).Conclusion:The magnitude of poor epilepsy treatment outcome was found to be high. The predictors of epilepsy treatment outcome were the history of head injury, family history of epilepsy and drug therapy problems. Therefore, to improve the treatment outcome of epileptic patients, health care providers should pay close attention to the identified factors. Besides this, the clinical pharmacy service should be implemented to minimize any medication-related problems

World Health Organization meningioma grade II.

We are presenting to you a magnetic resonance imaging (MRI) finding of a 65 years old female who presented to us with a complains of headache which was over the frontal region and on and off in nature. The patient also complains of imbalance during walking andtingling, numbness and weakness in the left upper and lower extremity. She gives a history of 2 episodes of seizures. Contrast magnetic resonance imaging findings revealed a well-defined extra-axial lesion measuring approximately 4.1*3.9cm (Red arrow and green arrow) in the parafalcine region at the right frontoparietal lobes with mass effect (Blue arrow). In contrast, the lesion shows avid peripheral enhancement with tiny non-enhancing central core features suggesting neoplastic etiology (Yellow arrow), i.e., World Health Organization Meningioma Grade II.Meningiomas, classified as Grade 2 by the World Health Organization, are aggressive tumors with a high recurrence rate that necessitates multiple surgical procedures and can significantly worsen a patient´s neurological condition. The lesion is hyperintense and homo-dense near the coronal suture. She underwent surgical excision of the right frontoparietal parasagittal tumor and is under regular physiotherapeutic and medical management for the residual weakness.

Brain abscess a grave complication of tetralogy of fallot: a rare clinical image.

A three-year-old female child presented to our OPD with complaints of multiple episodes of seizure in one day. On examination, she had tachycardia and tachypnea; saturation was 60 % to 76% in all four limbs, DTR was exaggerated, plantar jerks were extensor, central cyanosis, and grade III clubbing, and systolic ejection murmur on auscultation. She had no previous history of dyspnea and seizure. A complete blood count was suggestive of a white blood count of 17300 with neutrophilic predominance. 2Decho done was suggestive of tetralogy of fallot. The patient was planned for magnetic resonance imaging of the brain. MRI brain was suggestive of a multi-located lesion in the left frontotemporal lobe suggestive of cerebral abscess, causing a midline shift of 4mm to the right side. The patient was started on ceftriaxone at 75mg/kg/day, amikacin at 15mg/kg/day and injection leverage at 20mg/kg/day, propranolol at 2mg/kg/day. A neurosurgery opinion was taken. She was planned and taken for surgery. Left frontal craniotomy was done with excision of the abscess wall. Histopathological examination confirmed the diagnosis of brain abscess. She was kept in PICU post-surgery, and antibiotics were continued for 14 days. Post-surgery she had no new episode of seizure. She was planned for cardiac surgery 1 and half months after craniotomy (A, B, C).