Clinical profile of seizure disorder in hospitalized patients in tertiary care center - A prospective cross-sectional study

Background: Knowledge regarding people affected with epilepsy is essential for accurate planning and management of patients. This study was conducted to study clinical profile of seizure disorder in the patients hospitalized in a tertiary care hospital of Tamil Nadu. Aims and Objectives: To study clinical profile of seizure disorder in patients hospitalized in Coimbatore government medical college hospital. Materials and Methods: This study was a single center hospital based cross-sectional study of the clinical profile of seizure disorder in hospitalized patients at tertiary care center of Tamil Nadu, Neurology department the 2 years from 2018 to 2020. All the patients presenting with complaints of seizures were included in this study. Results: This study included a total of 321 patients with epilepsy. Their ages ranged between 10 and 100 years. 180 of the study population were males and 141 were female patients. 30% of patients had new onset seizures. Fever precipitated seizure in 16% of the subjects. Excitation, sleep deprivation, fever, watching television, and head trauma showed a strong association with generalized epilepsy. The majority of the patients had generalized tonic-clonic seizure, followed by focal neurological deficit. 98% of patients responded to treatment and they did not had recurrent episodes of seizure. Conclusion: The sample size of our cohorts is relatively small. It is possible that some prognosis factors may be missed due to the small sample size. Further studies with a larger sample cohort are required. Uneducated and low socioeconomic make people vulnerable to seizures because of lack of awareness, poor compliance to medicines, not detection of seizure provoking factor, repeated exposure to seizure provoking factor, prevalence of alcoholism, and thus lowering seizure threshold. There is a treatment gap still because of epilepsy and appropriate usage of resources will help to reduce this treatment gap and decreases epilepsy associated morbidity and mortality.

Ictal Syncope or Isolated Syncope? A case report highlighting the overlap

Background Ictal bradyarrhythmia is a rare condition defined by temporal lobe epilepsy resulting in bradycardia or asystole and can result in syncope. This needs to be differentiated from isolated syncope in patients with seizure disorder, as treatment strategies differ. Case Summary A 50-year-old female with well-controlled temporal epilepsy and a 20-year seizure-free period presented to her neurologist with abrupt onset of sudden drop attacks, thought to be ictal events with potential underlying ictal bradyarrhythmia and was initially treated with escalation of anti-convulsant therapy. However, her workup was consistent with a diagnosis of cardiac syncope. She subsequently underwent successful insertion of a pacemaker, with no recurrence of her presenting episodes at a 13-month Follow-up. Discussion Ictal syncope and isolated syncope may share a common terminal pathway and may have similar presenting symptoms. In patients with known seizure disorder, loss of consciousness may be attributable to epileptic events, ictal syncope, or isolated syncope—which can be difficult to differentiate. This case highlights the ambiguous nature of such episodes and the importance of simultaneous EEG/ECG monitoring, as this can have implications on treatment.

Co-morbidity of attention deficit hyperactivity disorder among children with seizure disorders at University of Gondar referral hospital Ethiopia (2016)

Attention deficit hyperactivity disorder is a disorder in which a person is unable to control behavior due to difficulty in processing neural stimuli, accompanied by an extremely high level of motor activity. The prevalence is much higher ranging from 8 to 77% among children with seizure disorders than in the general population. When attention deficit hyperactivity disorder presents in children with seizure disorder, it makes the treatment complicated and the prognosis poor. Hence, understanding the magnitude of attention deficit hyperactivity disorder and associated factors would be important to have a policy intention towards these people and to design appropriate interventions. Therefore, the current study was conducted to determine the comorbidity of attention deficit hyperactivity disorder and associated factors in children with seizure disorders. A hospital-based cross-sectional study was conducted by taking 260 children who have follow ups in the pediatric seizure clinic. The systematic random sampling technique was used to recruit participants. A structured, pretested and interviewer-administered questionnaire which included questions on associated factors and standard disruptive behavioral disorder rating scale was used to collect data. Data were coded, entered and cleaned by using the Epi-Data version 3.1 and exported to SPSS version 20 for further analysis. The multivariate binary logistic regression was used to check the association between independent and dependent variables. Variables with significant associations were identified based on adjusted odds ratio, with a 95% CI and p-value of < 0.05 will be considered as statistically significant. The prevalence of attention deficit hyperactivity disorder among epileptic children was found to be 115 (44.2%),with a confidence interval of (38.1–50.5),out of which only 3 (2.6%) were detected as having mental health problems by the clinician. The predominant subtype was inattentive type 96 (61.1%). Factors significantly associated with attention deficit hyperactivity disorder were male sex (AOR = 2.70 CI 1.46–4.97), family history of seizure disorder (AOR = 2.42 CI 1.26–4.65), family history of mental illnesses (AOR = 4.14 CI 1.76–9.68), sudden onset of the seizure (AOR = 2.37 CI 1.32–4.27), and uncontrolled seizure (AOR = 2.55 CI 1.41–4.61). Attention deficit hyperactivity disorder was common among children with seizure disorders in the study area. Male sex, sudden onsets of seizure, family history of seizure, and that of other psychiatric disorders as well as uncontrolled seizures were factors that increased the odds of attention deficit hyperactivity disorder. Therefore, interventions that would address such factors would help to overcome further complications.

Electroencephalography: Experience at Abakaliki Nigeria

BACKGROUND: Electroencephalography (EEG) remains the most important investigative modality in the evaluation of individuals with epilepsy and other neurological disorders. The pattern of EEG done in a tertiary hospital at Abakaliki Nigeria is not known. It is against this background that we embarked on this retrospective observational study on the EEG pattern and patient characteristics in Neurophysiology laboratory at Abakaliki Nigeria. METHOD: This is a retrospective observational hospital based study where the attendance register of the Neurophysiology laboratory was used to extract information on the demography, clinical characteristics and EEG reports of patients seen at the Laboratory from November 2018 to April 2021. RESULTS: A total of 125 (Male- 69, Female- 56) persons did EEG over the study period, and 75.2% had epileptiform waves (generalized- 16.8%, focal- 57.6%).&nbsp; CONCLUSION: EEG services are been utilized at Abakaliki in evaluation of seizure disorder and other paroxysmal neurological events with more prevalent focal epileptiform waves.