PD-1 Is an Immune-Inflammatory Potential Biomarker in Cerebrospinal Fluid and Serum of Intractable Epilepsy

Purpose. Previous studies have demonstrated that immune and inflammatory factors play an important role in recurrent seizures. The PD-1-PD-L pathway plays a central and peripheral immunosuppressive role by regulating multiple signaling pathways during the inflammatory and immunologic processes. This study is aimed at assessing PD-1 levels in cerebrospinal fluid (CSF) and serum samples from patients with intractable epilepsy. Methods. PD-1 levels were assessed in CSF and serum samples from 67 patients with intractable epilepsy (41 and 26 individuals with partial seizure and intractable status epilepticus, respectively) and 25 healthy controls, using flow cytometric analysis and sandwich enzyme-linked immunosorbent assays (ELISA). Results. Serum-PD-1+CD4+CD25high Treg levels in the experimental groups and the control group were 10.26 ± 2.53 (PS group), 35.95 ± 27.51 (ISE group), and 4.69 ± 2.44 (control group). In addition, CSF-PD-1 level in patients with epilepsy was higher than that in the control group ( 50.45 ± 29.56 versus 19.37 ± 4.51 ), indicating a statistically significant difference ( P < 0.05 ). Interestingly, serum- and CSF-PD-1 levels in individuals with epilepsy were not affected by antiepileptic drug and treatment course, but by epilepsy onset level. Of note, the increase of CSF- and serum-PD-1 levels was more pronounced in subjects with intractable status epilepticus than those with partial seizure. Conclusion. Serum- and CSF-PD-1 levels constitute a potential clinical diagnostic biomarker for intractable epilepsy and could also be used for differential diagnosis.

Artificial Neural Network analysis of EEG waves in complex partial seizure patients

Background: Brain dynamics associated with epilepsy remains limited. EEG-based epilepsy diagnosis and seizure detection is still in its infancy. The problem is further amplified for the design and development of automated algorithms, which requires a quantitative parametric representation of the qualitative or visual aspect of the markers. This study proposes an automatic classification system for epilepsy based on neural networks and EEG signals. Material and Method: The present study made use of EEG data from 16 controls and 16 temporal lobe epilepsy (TLE) patients in order to comparatively assess neural dynamics in normal healthy young adults and epileptic patients treated with anti-epileptic drugs in the context of resting state during eye close session. Such tangible differences could be appreciated through artificial neural network (ANN) classifiers. Results: During eye closed session of EEG in order to diagnose temporal lobe epileptic patient, the extracted features of EEG activity are given to the classifier algorithm for training and test performance. Artificial Neural Network (ANN) classifier was used for the diagnosis task. Fractal dimension (Katz, Higuchi and Permission entropy) were analyzed, in which the best results was observed in trained set of data of Katz (93.18%). Conclusion: Non-linear analysis plays an important role in prediction of complex partial seizure during interictal period.

Partial Seizures, Etiologies and Associated Comorbidity Factors

Background: Partial seizure is well-defined as sudden extreme, profligate, and limited electrical discharges by gray matter from some portions of the brain due to certain structural & metabolic abnormalities. Objective: To distinguish the etiologies of partial seizures and to clarify its association with the age of affected patients. Patients and Methods: A prospective study, done on all patients with neurological consultation in Al- Batool Teaching Hospital, Baqubah Teaching Hospital and Al Yarmouk teaching Hospital from Nov, 2016 to Dec, 2018. Patients with partial seizures and/with secondary generalization were merged. This was fortified through a full history, physical checkup, EEG, and MRI of the brain. The study’s sample comprising 106 patients with partial seizures, the age ranged from 6-75 years, with 52 males and 54 females. Results: Atypical neuroimaging was found in (61%) of patients. Tumors occurred in (19.7%) of patients, the highest of them below 40 years of age while infarctions comprised 25.5% of patients outside this age. Complex partial seizures(CPS) patients with temporal lobe foci comprised 83.7 % and (16.2%) had frontal lobe problems, while (49%) of Simple partial seizures (SPS) patients had frontal lobe foci, 22% frontoparietal and 13% had parietal lobe foci and had brain lesions were spotted in 75.4% of patients with SPS and (35.1%) with complex partial seizures. Conclusion: Infarction is a common reason for partial seizures in patients above 40 years while below this age the tumor is common etiology. A partial seizure is connected mostly with brain lesions. Keywords: Partial seizures, comorbid factors, brain lesions

Management Strategy of Patients Attending at Epilepsy Clinic in a Tertiary Care Hospital of Bangladesh

Background: Epilepsy is a neuronal disorder that is observed globally but still it is not explored very well in most parts of the world. Objective: The aim of our study was to determine the types of epilepsies along with their treatment strategies among patients attending the outdoor epilepsy clinic in a referral tertiary care hospital. Methodology: This cross sectional study was carried out from the records of weekly epilepsy clinic of Department of Neurology at National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from January 2018 to August 2019. Data were collected through a predesigned questionnaire containing information about demography, clinical features, EEG and imaging findings and treatment of patients. Results: A total number of 1832 patients were recruited. There was a male (55.3%) and urban (61.1%) predominance. Most (75.1%) of the patients were young (age range from 10 to 29 years). A large number of patients were student (44.4%) and 24.2% were unemployed. The duration of epilepsy in most patients were less than 5 years (40.7%). 58.3% patients took various forms of indigenous treatment prior to attending this clinic. 54.7% patients had no comorbid illness. EEG was abnormal in 34.5% patients of which 24.4% had focal abnormality and 10.1% had generalized epileptic discharge. In brain imaging (CT/MRI) only 16.4% showed abnormal findings. 49.5% patients were suffering from generalized epilepsy whereas 44.6% had partial epilepsy. Among the generalized epilepsy group, most of them had generalized tonic clonic seizure (GTCS) (75.4%), while 8.9% had absence seizure and 7.9% had tonic seizure. In partial epilepsy group, the majority were secondary generalized seizure (74.7%), followed by complex partial seizure (CPS) (18.7%) and simple partial seizure (6.6%).42.7% patients got single antiepileptic drug whereas 37.4% patients received dual drug. Polytherapy (three or more drugs) were prescribed in 14% patients. Valproic acid was the highest prescribed drug (29.3%) either as monotherapy or in combination. Carbamazepine (27.4%) was the second common drug followed by Levetiracetam (15.1%). Conclusion: Epilepsy affects almost all groups of the society. Most of the patients remain seizure-free with judicious anti-epileptic drugs. Therefore, more effort is needed for early accurate diagnosis and appropriate treatment of epilepsy Journal of National Institute of Neurosciences Bangladesh, 2020;6(1): 3-8

Study of intracranial structural lesions diagnosed by computed tomography among children with unprovoked seizure disorder

Background: Seizures are the most common pediatric neurological disorder. The objectives were to know the prevalence and types of intracranial structural lesions diagnosed by Computed Tomography in children with unprovoked seizures.Methods: It is hospital based cross-sectional study done in Patna Medical College, India from August 2005- July 2007. All patients aged 6 months to 12 years admitted in pediatrics department with at least 2 episodes of unprovoked seizures were undergone Computed Tomography brain.Results: Out of total 112 patients admitted, 66.1% had abnormal CT scan. Prevalence of abnormal CT scan increased with advancing age and significant, with maximum percentage found in age group 10-12 years (43.2%). Males had more seizures and intracranial lesion than females but this association was statistically non-significant. 65.2% had generalized seizure and 34.8% had partial seizure. Among patients with abnormal CT scan, generalized seizure (70.3%) and partial seizure (29.7%).The commonest probable diagnosis was tuberculoma (47.3%) followed by neurocysticercosis (25.7%) and brain abscess (4%). Other were atrophy, gliosis and hydrocephalus, 2.5% each; arachnoid cyst, extradural hematoma, sturge weber syndrome, tuberous sclerosis, infarct, hemiatrophy, caudate lobe hemorrhage, basal ganglia calcification, corpous callosum agenesis, 1.35% each.Conclusions: Inflammatory granuloma is the leading cause of unprovoked seizure in this part of the country. Every seizure case should undergo a CT scan examination. Preventive measures can be applied for tuberculoma and NCC so as to lower down the burden of seizure disorder.