Cerebral Toxoplasmosis in Systemic Lupus Erythematosus

A 37-year-old man with underlying systemic lupus erythematosus and lupus nephritis presented with an episode of generalized tonic seizure. He complained of poor concentration and forgetfulness for 1 week. He suffered a relapse of lupus nephritis 4 months ago and received a course of intravenous methylprednisolone followed by oral prednisolone and mycophenolate mofetil. Clinically, there was no focal neurological deficit. Retroviral screening was negative. Magnetic resonance imaging (MRI) of the brain revealed eccentric and concentric signs which confirmed the diagnosis of cerebral toxoplasmosis.

Calcifying pseudoneoplasm of the neuraxis (CAPNON) associated with neurenteric cyst: an autopsy case showing unusual fatal outcome

Background Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare calcified tumefactive lesion that can occur in the brain or spine. Although the aetiology and natural course of CAPNON has not yet been fully established, recent study reported that many CAPNON cases have dual pathology, which may be associated with its aetiology. Case presentation A 53-year-old man with a history of an untreated brain mass was taken to a hospital by emergency transport. A computed tomography scan revealed an intracranial hypo-attenuated mass exhibiting mass effect. Several calcified foci were observed around the lesion. He suddenly showed tonic seizure after admission, therefore an emergency craniotomy was performed. However, he unfortunately died due to advanced cerebral oedema. Microscopic findings of the surgically obtained materials were consistent with neurenteric cyst (NC). Intracranial hard masses were found adjacent to NCs and the masses were composed of fibrous cartilage-like matrix with massive linear calcification and surrounding round-to-oval epithelioid cells. Conclusion CAPNON associated with NC was considered to be most appropriate diagnosis of present case. To the best of our knowledge, this is the first report of such case. The present case suggests that delay of treatment may cause a poor outcome, at least in CAPNON associated with NC. Careful investigation, including of the underlying pathology, may be essential for deciding treatment strategies for CAPNON.

SURG-19. COMPLETE RESOLUTION OF ADHD AFTER GROSS TOTAL RESECTION OF DYSEMBRYIOPLASTIC NEUROEPITHELIAL TUMOR

A 3-year-old boy with a history of attention-deficit/hyperactivity disorder (ADHD) presented a single focal tonic seizure. A thorough physical examination revealed no neurological deficit. A contrast enhanced MRI showed an isointense lesion in the anterior part of the cingulate gyrus extending through the left frontal lobe. After initial evaluation, the parents refused surgical treatment and a close follow up was then considered. At the age of five, the ADHD become more evident and the patient was started on methylphenidate. Poor clinical response was seen with the initiation of stimulant. The boy presented a second generalized seizure and the parents agreed surgical management. An interhemispheric approach was then performed and a gross total resection was achieved. The histopathological diagnosis corresponded to a dysembryoplastic neuroepithelial tumor (DNET). Four years after the resection, the patient is seizure free and the ADHD has also resolved without the need of medication. The disappearance of seizures is common after surgical resection of DNET tumors, but this case establishes an association with ADHD.

Bilateral asymmetric tonic seizure in insulo-opercular epilepsy: an anatomo-electro-clinical study

Background Insulo-opercular seizures are highly heterogeneous in seizure semiology and electrical features. Bilateral asymmetric limb posturing, as a classical pattern of supplementary sensorimotor area (SMA) seizure, also occurs in insulo-opercular epilepsy. This study was aimed to study the anatomo-electro-clinical correlations in bilateral asymmetric tonic seizures (BATS), in order to advance the understanding of insulo-opercular epilepsy. Methods Eight patients with insulo-opercular epilepsy as confirmed by stereoelectroencephalography (SEEG) and manifesting BATS as the major ictal motor sign, in Guangdong Sanjiu Brain Hospital Epilepsy Center from 2014 to 2018, were employed in this study. The BATS of the patients were evaluated, and the semiologic features and concomitant intracerebral EEG changes were quantified. Then the variables were examined with Cluster Analysis, and the semiologic features were correlated with anatomic localization using the Kendall correlation test. Results Of the 8 patients, the most frequent initial motor sign was bilateral asymmetric tonic posturing (62.5%). Facial tonic-clonic sign also had a high prevalence in the evolution of seizures (87.5%). The results of Cluster Analysis showed that the semiologic features were subdivided into two main groups, one group comprising exclusively BATS and the other including signs of focal tonic seizure, aura, focal limb tonic-clonic seizure (TCS), facial TCS, hypermotor behavior, eye movement, autonomic changes and generalized TCS. The BATS was strongly associated with the posterior long gyrus (PLG) of insula (t = 0.732) and parietal operculum (t = 1.000); the hypermotor behaviors were associated with the anterior long gyrus (ALG) (t = 0.770); and the autonomic changes were associated with the anterior limiting sulcus (ALS) (t = 0.734) and middle short gyrus (MSG) (t = 0.700). Conclusions The seizure semiology of insulo-opercular epilepsy is characterized, in temporal order, by BATS, with or without simultaneous hypermotor behaviors, and frequently ends up with facial tonic-clonic signs, which is different from that of the SMA seizure. The early spread network involving the posterior insular lobe and parietal operculum may contribute to this pattern of manifestation.

Effect of Curcuma zedoaria hydro-alcoholic extract on learning, memory deficits and oxidative damage of brain tissue following seizures induced by pentylenetetrazole in rat

Background Previous studies have shown that seizures can cause cognitive disorders. On the other hand, the Curcuma zedoaria (CZ) has beneficial effects on the nervous system. However, there is little information on the possible effects of the CZ extract on seizures. The aim of this study was to investigate the possible effects of CZ extract on cognitive impairment and oxidative stress induced by epilepsy in rats. Methods Rats were randomly divided into different groups. In all rats (except the sham group), kindling was performed by intraperitoneal injection of pentylenetetrazol (PTZ) at a dose of 35 mg/kg every 48 h for 14 days. Positive group received 2 mg/kg diazepam + PTZ; treatment groups received 100, 200 or 400 mg/kg CZ extract + PTZ; and one group received 0.5 mg/kg flumazenil and CZ extract + PTZ. Shuttle box and Morris Water Maze tests were used to measure memory and learning. On the last day of treatments PTZ injection was at dose of 60 mg/kg, tonic seizure threshold and mortality rate were recorded in each group. After deep anesthesia, blood was drawn from the rats’ hearts and the hippocampus of all rats was removed. Results Statistical analysis of the data showed that the CZ extract significantly increased the tonic seizure threshold and reduced the pentylenetetrazol-induced mortality and the extract dose of 400 mg/kg was selected as the most effective dose compared to the other doses. It was also found that flumazenil (a GABAA receptor antagonist) reduced the tonic seizure threshold compared to the effective dose of the extract. The results of shuttle box and Morris water maze behavioral tests showed that memory and learning decreased in the negative control group and the CZ extract treatment improved memory and learning in rats. The CZ extract also increased antioxidant capacity, decreased MDA and NO in the brain and serum of pre-treated groups in compared to the negative control group. Conclusion: It is concluded that the CZ extract has beneficial effects on learning and memory impairment in PTZ-induced epilepsy model, which has been associated with antioxidant effects in the brain or possibly exerts its effects through the GABAergic system.

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

Novel 3-{4-[2-Amino-4-(Substitutedphenyl)-2H-[1, 3] Oxazin/Thiazin-6-Yl} -2-Phenyl-3H-Quinazolin-4-One Derivatives as Enhancer of GABA Mediated Inhibition: Synthesis, Molecular Modeling and Pharmacological Studies

Background: According to WHO, the 50 million people worldwide are suffering from epilepsy, making it one of the most common neurological diseases globally. Epilepsy is often characterized by neurobiological, cognitive, psychological and behavioral changes and that may enhance the susceptibility to seizures and affect the quality of life. Objective: The aim of the present work was to develop 2, 3 disubstituted 4-(3H)-quinazolinone derivatives in order to find an effective and highly lipophilic compound with lesser side effects and to evaluate them for anticonvulsant and neurotoxic activity. Methods: A novel series of 3-4-[2-amino-4-(substitutedphenyl)-2H-[1.3] oxazin/thiazin-6-yl 2- phenyl-3H-quinazolin-4-one derivatives were synthesized and evaluated for their anticonvulsant activity. The structures of the compound have been confirmed by spectral analysis. The molecular docking study was performed for finding the binding affinity with GABAA receptor in order to rationalize their anticonvulsant activities in a qualitative way. Quantitative estimate of drug-likeness was also performed which calculate the molecular properties and screen the molecules based on drug-likeness rules. Anticonvulsant activities of synthesized compounds were done by using (Maximal electroshock) MES induced seizures and subcutaneous pentylenetetrazole (scPTZ) induced seizure models in Wistar rats of either sex. None of the compounds demonstrated any sign of neurotoxicity. Results: Compounds 3-4-[2-amino-4-(fluorophenyl)-2H- [1, 3] oxazin-6-yl 2-phenyl-3H quinazolin-4-one (5i) and 3-4-[2-amino-4-(fluorophenyl)-2H- [1, 3] thiazin -6-yl 2-phenyl-3H quinazolin-4-one (5n) have shown significant activity against tonic seizure by the MES model and clonic seizure by scPTZ induced seizure model. Conclusion: These ten novels synthesized compounds had significant anticonvulsant activity. As a result, the compound (5i) and (5n) emerged out as the pilot molecule with a better anticonvulsant activity without any neurotoxicity, while the other compounds have moderate activity. QED analysis of compounds (5i) and (5n) also indicated that these compounds will have good oral absorption. The proposed work is to make efforts towards the development and identification of novel molecules as anticonvulsant agents by the synthesis of some novel quinazolinone derivatives with improved biological activity.