Anxiety and Depression in School-going children with Epilepsy

Background: This study was designed to find the prevalence of anxiety and depression in school-going children with epilepsy.Methods:All the patients with epilepsy presenting during the study period underwent detailed clinical and EEG evaluation. Hospital Anxiety and Depression score (HADS) was used to screen for anxiety and depression.Results:We identified 190 patients with epilepsy during the study period. Out of these 30 (15.8%) were diagnosed as having treatment resistance epilepsy. Anxiety was diagnosed in 114 (60%) and depression in 62 (32.6%). Patients with drug resistant epilepsy were found to have statistically significant markers in the form of higher scores for depression and anxiety, and lower IQ scores. Frequency of GTCS (Generaized Tonic Clonic Seizures) showed inverse correlation with IQ scores and direct correlation to the anxiety/depression scores.Conclusion:We conclude that anxiety and depression in school-going children with epilepsy is common and that it has a correlation with treatment resistance.

Endogenous and exogenous serotonin, but not sumatriptan, ameliorate seizures and neuroinflammation in the pentylenetetrazole-induced seizure model in rats

ABSTRACT Background: Epilepsy has neuropsychiatric comorbidities such as depression, bipolar disorder, and anxiety. Drugs that target epilepsy may also be useful for its neuropsychiatric comorbidities. Objective: To investigate the effects of serotonergic modulation on pro-inflammatory cytokines and the seizures in pentylenetetrazole (PTZ)-induced seizure model in rats. Methods: Male Wistar rats were injected intraperitoneally with serotonin, selective serotonin reuptake inhibitor fluoxetine, 5-HT1B/D receptor agonist sumatriptan, or saline 30 min prior to PTZ treatment. Behavioral seizures were assessed by the Racine's scale. Concentrations of IL-1β, IL-6, and TNF-α in serum and brain tissue were determined by ELISA. Results: Serotonin and fluoxetine, but not sumatriptan, alleviated PTZ-induced seizures by prolonging onset times of myoclonic-jerk and generalized tonic-clonic seizures. The anti-seizure effect of fluoxetine was greater than that of serotonin. Likewise, serotonin and fluoxetine, but not sumatriptan, reduced PTZ-induced increases in the levels of IL-1β and IL-6 in both serum and brain tissue. None of the administered drugs including PTZ affected TNF-α concentrations. Conclusions: Our findings suggest that endogenous and exogenous serotonin exhibits anticonvulsant effects by suppressing the neuroinflammation. It seems that 5-HT1B/D receptors do not mediate anticonvulsant and anti-neuroinflammatory effects of serotonin.

A study of brain functional network and alertness changes in temporal lobe epilepsy with and without focal to bilateral tonic–clonic seizures

Background Temporal lobe epilepsy (TLE) is commonly refractory. Epilepsy surgery is an effective treatment strategy for refractory epilepsy, but patients with a history of focal to bilateral tonic-clonic seizures (FBTCS) have poor outcomes. Previous network studies on epilepsy have found that TLE and idiopathic generalized epilepsy with generalized tonic-clonic seizures (IGE-GTCS) showed altered global and nodal topological properties. Alertness deficits also were found in TLE. However, FBTCS is a common type of seizure in TLE, and the implications for alertness as well as the topological rearrangements associated with this seizure type are not well understood. Methods We obtained rs-fMRI data and collected the neuropsychological assessment data from 21 TLE patients with FBTCS (TLE- FBTCS), 18 TLE patients without FBTCS (TLE-non- FBTCS) and 22 controls, and constructed their respective functional brain networks. The topological properties were analyzed using the graph theoretical approach and correlations between altered topological properties and alertness were analyzed. Results We found that TLE-FBTCS patients showed more serious impairment in alertness effect, intrinsic alertness and phasic alertness than the patients with TLE-non-FBTCS. They also showed significantly higher small-worldness, normalized clustering coefficient (γ) and a trend of higher global network efficiency (gE) compared to TLE-non-FBTCS patients. The gE showed a significant negative correlation with intrinsic alertness for TLE-non-FBTCS patients. Conclusion Our findings show different impairments in brain network information integration, segregation and alertness between the patients with TLE-FBTCS and TLE-non-FBTCS, demonstrating that impairments of the brain network may underlie the disruptions in alertness functions.

Sodium Valproate Combined With Topiramate vs. Sodium Valproate Alone for Refractory Epilepsy: A Systematic Review and Meta-Analysis

Background: Among antiepileptic drugs (AEDs), sodium valproate alone or in the combination of topiramate (TPM) for treating refractory epilepsy was controversial. This meta-analysis aimed to systematically evaluate the clinical effects of these two regimens in this population.Methods: Relevant studies up to August 2021 were identified through systematic searches of CNKI, Wanfang, PubMed, and Embase databases. We assessed the effectiveness and the frequency of absence seizures, atonic seizures, and tonic–clonic seizures. The included literature's risk of bias was evaluated using the Cochrane Collaboration's Risk of Bias tool. Sensitivity analysis was conducted to confirm the results' stability. STATA 15.0 was utilized for all pooled analyses in the included studies.Results: Totally 10 articles were determined for our meta-analysis, involving 976 patients with epilepsy in total (combined group, n = 488; monotherapy group, n = 488). The results of this meta-analysis indicated that the total effective rate of sodium valproate combined with TPM was higher than that of sodium valproate alone (random-effect model: OR = 3.52; 95% CI 1.47 to 8.47; p < 0.001; I2 = 73.8%). The frequency of absence seizures in the combined group was lower (fixed-effect model: WMD = −6.02; 95% CI −6.50 to −5.54; I2 = 0.0%) than that in the monotherapy group, with a statistical difference (p < 0.05). The combined group had lower frequency of atonic seizures (WMD = −4.56, 95% CI −6.02 to −3.10; I2 = 82.6%) and lower frequency of tonic–clonic seizures (WMD = −3.32; 95% CI −4.75 to −1.89; I2 = 96.4%). In addition, the distinct difference of adverse events was non-existent between two groups.Conclusions: Sodium valproate combined with TPM was more effective than sodium valproate alone for epilepsy therapy. This meta-analysis provides feasibility data for a larger-scale study on AED therapy of refractory epilepsy and may contribute to better therapy strategies for epilepsy clinically.

Exceptionally rapid recurrence of malignant meningioma: case report

Anaplastic meningioma represents less than 5% of all meningiomas. It is a neoplasm with a poor prognosis due to aggressiveness and a high rate of recurrence. Patients could remain asymptomatic but clinical characteristics of mass effect are the most common presentation. Although diagnosis is made with histological study, this method is difficult to define, with inter-observer variability. When possible, surgical resection is the primary management. We discuss a case of an adult female patient with tonic-clonic seizures and weakness attributed to an anaplastic meningioma in the occipital lobe. The patient was treated with a parietal craniotomy with complete resection. One month later the patient suffered a recurrence of the tumor with the need for further intervention with incomplete resection. Due to extent of the damage the patient deceased two weeks later.

Therapeutic possibilities of coriaria myrtifolia L. in high dilutions

Background: Homeopathy literature shows references about Coriaria myrtifolia L. at some important Homeopathic Materia Medica: Allen,TF [1], Voisin H [2] and Vijnovsky B [3]. Those reports are unsatisfactory to fulfill a contemporary standardized study basis on: origin and description, preparation, medicine general action, sensations and modalities; demanding a broader investigation. Aims: Identify therapeutic possibilities on Coriaria myrtifolia L. from ratifying and broadening the homeopathic materia medica knowledge. Methodology: Literature review on botanical, biochemical and pharmacological data [4-12]. The use of plant in various fields since XVIII century and analyzes of clinical-toxicological reports described in medical reviews published. Results: Coriaria myrtifolia L. is a toxic shrub, growing wild in western Mediterranean region. The entire plant contains a sesquiterpene-lactone called coriamyrtin, a potent convulsivant neurotoxin. Clinical manifestations of acute intoxication includes: Central Nervous System – generalized tonic-clonic seizures, recurrent, which may evolve to status epilepticus, coma, apnea and death. Respiratory Tract – respiratory depression due to anoxia, respiratory arrhythmia alternating with apnea, respiratory muscles tetanization evolving to respiratory arrest. Cardiovascular System – central excitatory action which may initially promote increased blood pressure followed by heart failure, as a result of the seizures, due to anoxia and acidosis, leading to cardiac arrest. Gastrointestinal Tract – nausea, vomiting and stomach pains that precede seizures; since there is no evidence of toxin direct action on mucosa, those symptoms may relate to Central Nervous System action (attributed to impairment of cranial nerve VIII). Knowledge of these aspects gave us possibility to build a Coriaria myrtifolia L. materia medica with broader clinical indications. Conclusion: Coriaria myrtifolia L. is a valuable source to be used in high dilutions as medicine indicated for epileptic syndromes treatment, characterized by tonic-clonic seizures, mainly presenting a malignant tendency, with recurrent seizures, which may evolve to status epilepticus and potential mortality risk. Among the clinical indications proposed stand out etiologies of great incidence at emergency rooms such as metabolic or vascular primary disorders, or resulting from systemic diseases (diabetes, hepatopathy, nephropathy), encephalitis and meningitis with or without Acquired Immunodeficiency Syndrome, withdrawal syndrome from alcohol or drugs, exogenous poisoning, poisoning or overdose of alcohol or drugs, traumatic brain injury and intracranial expanding lesions.

Advanced Collateral Physiotherapy Management for Pneumothorax Following Dengue Encephalitis: A Case Study

Dengue fever is a mosquito-borne sickness that has become a serious international public health issue in recent years.A 54 years old male patient, farmer by occupation came to rural hospital on 10TH September 2021 with complaint of fever associated with chills and rigors, slurring of speech 2 days back and 2 episodes of generalized tonic clonic seizures. Dengue was confirmed by the non-structural protein 1 (NS1) antigen and immunoglobulin M (IgM) antibody test. Radiological investigations revealed encephalitis and pneumothoraxfor which medical management along with inter costal drainage and collateral physiotherapeutic rehabilitation was administered.The goals of the physiotherapy rehabilitation were to reduce bronchospasm, to clear secretions lung fields, to regain full expansion of lungs and best possible functional recovery. Physiotherapy management has shown satisfactory results in regaining pulmonary function.After the completion of the treatment the patient gained maximum re-expansion of the lungs, had no breathing difficulties, the lungs were clear of sputum and was functionally independent.

Large cavernous malformations in infant

Cavernous malformations are rare vascular malformations in the central nervous system. We present the case of a 2-month-old female patient who presented tonic-clonic seizures, with no previous history of seizures. Magnetic resonance imaging showed a 5.6 cm tumor in the left parieto-occipital region. The radiological aspect of the tumor initially suggested an anaplastic meningioma. After surgical treatment and anatomopathological analysis, it was found to be a cavernous malformation. Cavernous malformations, or cavernomas, are rare lesions and even more rare is the occurrence of large cavernomas. In the pediatric population, although still quite rare, they usually are presented as larger cavernomas. Surgical resection is considered the most effective treatment.

Screening for Activity Against AMPA Receptors Among Anticonvulsants—Focus on Phenytoin

The interest in AMPA receptors as a target for epilepsy treatment increased substantially after the approval of perampanel, a negative AMPA receptor allosteric antagonist, for the treatment of partial-onset seizures and generalized tonic-clonic seizures. Here we performed a screening for activity against native calcium-permeable AMPA receptors (CP-AMPARs) and calcium-impermeable AMPA receptors (CI-AMPARs) among different anticonvulsants using the whole-cell patch-clamp method on isolated Wistar rat brain neurons. Lamotrigine, topiramate, levetiracetam, felbamate, carbamazepine, tiagabin, vigabatrin, zonisamide, and gabapentin in 100-µM concentration were practically inactive against both major subtypes of AMPARs, while phenytoin reversibly inhibited them with IC50 of 30 ± 4 μM and 250 ± 60 µM for CI-AMPARs and CP-AMPARs, respectively. The action of phenytoin on CI-AMPARs was attenuated in experiments with high agonist concentrations, in the presence of cyclothiazide and at pH 9.0. Features of phenytoin action matched those of the CI-AMPARs pore blocker pentobarbital, being different from classical competitive inhibitors, negative allosteric inhibitors, and CP-AMPARs selective channel blockers. Close 3D similarity between phenytoin and pentobarbital also suggests a common binding site in the pore and mechanism of inhibition. The main target for phenytoin in the brain, which is believed to underlie its anticonvulsant properties, are voltage-gated sodium channels. Here we have shown for the first time that phenytoin inhibits CI-AMPARs with similar potency. Thus, AMPAR inhibition by phenytoin may contribute to its anticonvulsant properties as well as its side effects.