Clinical and Social Findings of Childhood Epilepsy

Background: Seizures are defined as a transient occurrence of signs and symptoms due to the abnormal, excessive, or synchronous neuronal activity in the brain characterized by abrupt and involuntary skeletal muscle activity. Seizure is related to specific risk factors like positive family history, fever, infections, neurological comorbidity, premature birth, mother’s alcohol abuse, and smoking in pregnancy. Epilepsy is the most frequent chronic neurologic condition in children. Studies have suggested declining incidence rates of childhood epilepsy in high-income countries during the last decades. Objective: To describe the clinical features and social findings of epilepsy in children, and to evaluate some risk factors associated with control of epilepsy. Patients and Methods: This cross-sectional study was conducted in the pediatric department of Albatool teaching hospital in Diyala province, Iraq. A total of 100 children were included in the study from February 2020 to May 2020. All children diagnosed with epilepsy in this study. Results: One hundred children with epilepsy, their mean age was 5.96± 3.33 years (range 1-14 years). Of the 48(48%) children were male and 52(52%). Of the total patients, 79% were free from seizure on AED, 21% of them were refractory to treatment.Patients without developmental delay (88.7%, p=0.012) can be controlled by AED. Patients who had idiopathic seizures (87.5%, p=0.04) can be controlled by AED. Patients who had seizure attacks can be controlled by AED more than patients who had weekly or monthly seizure attacks (97.4%) (p<0.001). Patients who had been treated by monotherapy (94.7%, p=0.012) can be controlled more than patients who were treated by multidrug therapy. Affected social interaction and need more supervision were factors that detected more in patients with refractory epilepsy, p=0.04, 0.01 respectively. While there was no association between frightened other people and epilepsy control. Conclusion: Most of the patients are characterized by: treatment approach monotherapy, less affected by social interaction and need less supervision. Patients with refractory epilepsy had opposite factors. Keywords: Epilepsy, Albatool teaching hospital.

Evaluation of Functional Outcome Following Resection of Supratentorial Lesions at Eloquent Brain Areas

Objectives Microsurgical management of intrinsic brain tumors aims to maximize the extent of resection and to minimize the postoperative morbidity. The purpose of this study is to evaluate the functional outcome following surgical excision of supratentorial lesions at eloquent brain areas such as language, motor and sensory cortex, regarding the extent of resection, the karnofsky performance scale, the neurological deficit and seizure control. Methods A prospective study of 25 patients aged 15-55 years, 15 females and 10 males underwent surgical excision of supra-tentorial lesions at eloquent brain, The Karnofsky Performance Score (KPS), seizure attacks and neurological deficits were analyzed before and after resection. Functional resection was implemented using preoperative functional magnetic resonance image (fMRI), intraoperative image guidance and electrophysiological monitoring under total intravenous anesthesia (TIVA) or awake craniotomy and the extent of resection was quantified postoperatively. Results Preoperative median KPS was 76.8%. It improved one year post-operatively to 89.2%. One patient died 3 weeks postoperatively due to neurological, cardiac and chest complications. The pathology report revealed recurrent metastatic adenocarcinoma GIII. Preoperatively, twenty-three patients had seizure attacks, 10 were controlled and 13 were uncontrolled on medication. Postoperatively seven patients were Engels classification IC and 17 patients were controlled on anti-epileptics (Engels classification ID). Preoperatively 19 patients had hemiparesis/ hemiplegia, while immediate (one week) postoperatively 13 patients improved, 8 patients experienced initial worsening of the preoperative deficits and 4 patients had the same deficit as preoperatively while at 1-year postoperatively, 24 patients improved. Gross total resection (&gt;95%) was achieved in 19 patients, subtotal resection (&gt;75%) in 4 patients and partial resection (&gt;65%) in 2 patients. Conclusion Functional resection is believed to be a key prognostic factor in supratentorial lesions at eloquent brain regarding improving of karnofsky performance scale, neurological outcome and seizure control.

A ROLE OF AYURVEDA IN THE MANAGEMENT OF APASMARA (EPILEPSY): A CASE STUDY

Apasmara (epilepsy) is defined as the apagama (deterioration) of smriti (memory) associated with bibhasta cheshta (seizures) due to derangement of dhi and satwa, mainly related to vata and rajo dosha vitiation, which effects both Sharira (body) and Mana (mind). The present antiepileptic drugs control the seizure attack, but long-term use generates adverse effect at cognitive level and leads to behavioral disorders, hence there is need of safe and effective treatment which not only controls seizure attack but helps to cure the disease. A 44-year-old man approached Kayachikitsa OPD with the complaints of frequent seizure attacks, since from at the age of one and half year with regular oral antiepileptic drugs medications (allopathic), the dose of medications increasing yearly and he was not satisfied with treatment, so he was advised with Panchakarma treatment starting from Deepana, Pachana, Vamana (medicated emesis), Virechana (medicated purgation), Basti (medicated enema), Shirodhara along with palliative treatment. After each treatment it was observed that the patient was satisfied with treatment and the complaints of seizure attack reduced in frequency and duration with improved quality of life. Palliative treatment was advised to continue along with modern medications.

Alive Animal Model for Epilepsy by Intradorsal Striatum Injection of Colchicine

Background Epilepsy is a neural disorder with repeatable seizure attacks. We used the neurotoxin colchicine, which is derived from the plant Colchicum autumnale, to introduce a low cost but the more valuable alive animal model for epilepsy. Materials and Methods Wistar rats weighing 250 to 300 g after intraperitoneal injection of ketamine (100 mg/kg) and xylazine (20 mg/kg) were restrained in the stereotaxic apparatus; they were cannulated in the dorsal striatal area (AP: 0.5 mm; L: 3 mm; V: 3.6 mm). One week later, an injection cannula attached to a 5-µ Hamilton syringe by polyethylene tubing guided 0.05 to 25 μg/rat colchicine in the recovered healthy rats once daily for 4 consecutive days. The control group solely received the saline solution. The behavioral signs of all animals were daily recorded. Finally, the brains of rats under deep euthanasia were collected in 10% formalin and examined histopathologically. The dorsal striatal regions were cut coronally into 3 to 4 µm-thick slices, and then stained with hematoxylin-eosin. They were eventually examined under the light microscope to verify the injection placement or possibility of lesions. All data were analyzed by analysis of variance under α = 0.05. Results Behaviors were quantified based on Racine five-stage scoring and showed the significant epileptic generalized seizures in alive animal treated by intrastriatal injection of colchicine. However, tissue damage was invisible in the target brain area. Conclusion The colchicine, using injection successively into the dorsal striatal region of rat, can create recurring epileptic convulsions in the animal.

Medication-precipitated Seizure in Psychiatric Patients: Typical vs. Atypical Antipsychotics

Backgrounds: It is unknown whether second-generation antipsychotics are safer than first-generation antipsychotics in terms of seizure induction. Objective: In the present assessment, the relationships between the incidence of seizure attacks among a great sample of non-western psychiatric inpatients and prescribed typical and atypical antipsychotics have been probed and analyzed based on the existing data in the literature. Methods: Razi psychiatric hospital, as one of the largest and oldest public psychiatric hospitals in the Middle East, had been selected as the field of study in the present retrospective estimation. For assessment, all inpatients that had suffered a seizure during the last sixtyfour months had been included in the current study. Results: Among seventy-four patients who had experienced seizure attack during the inpatient management, and had been prescribed antipsychotics for symptomatic management of primary psychiatric disorders, 67.56% had received atypical antipsychotic and the remaining (32.43%) had received typical antipsychotics, which revealed a significant quantitative difference between them (p<0.000). Among atypical antipsychotics, olanzapine was the most recommended antipsychotic (33.78%), followed by risperidone (34%), quetiapine (9.45%), and clozapine (n=1, 1.35%). Among typical antipsychotics, too, haloperidol (28.37%) was significantly more prescribed than chlorpromazine (2.70%) and thioridazine (1.35%) (p<0.000). By the way, there was no significant difference, quantitatively, between olanzapine and haloperidol in the present evaluation (p<0.47). Conclusion: Atypical antipsychotics have comparable potentiality, as typical antipsychotics, for triggering seizure attacks, which demands indispensable cautiousness by clinicians when prescribing such a group of medications for epileptic and neuropsychiatric patients.

COVID-19 and Epilepsy

Introduction: COVID-19 caused by SARS-CoV-2 acquired via respiratory droplets. It can present with many systemic disorders, includingA 45-year-old Sudanese male known to have well-controlled generalized tonic-clonic epilepsy, He presented to the Accident and Emergency (A&E) department complaining of refractory status epilepticus. Despite immediate initial stabilization, the seizure attacks were still refractory to intravenous loading doses of antiepileptic drugs AEDs. Hence the patient was intubated and mechanically ventilated. Brain MRI and EEG were normal. The chest X-ray was normal. The screening of COVID-19 was positive.Epilepsy is one of the most common neurological disorders. Since the beginning of the Coronavirus outbreak in December 2019, no available research data is suggesting that the patients with epilepsy are at more risk than others. As no available data relating epilepsy to severe COVID-19 infection (6). Moreover, no data studied COVID-19 and the sudden unexpected death among epileptic patients (SUDEP).Conclusion: This case might report the effect of SARS-CoV-2 on provoking the refractory seizures in a previously well-controlled patient with epilepsy. More researches are needed to explain the relation between COVID and seizure threshold.

TEACHERS’ KNOWLEDGE, ATTITUDES AND PRACTICES TOWARD EPILEPSY IN TARKWA-NSUAEM MUNICIPALITY

Purpose: The objective of this study was to assess the knowledge, attitudes and practices of basic school teachers on epilepsy in Tarkwa-Nsuaem Municipality.Methodology: The study employed a descriptive cross-sectional design. Teachers were sampled from public basic schools in the municipality using the Yamane’s formula for known sampling frame to arrive at 226 participants for the study. The multi-stage and convenience sampling techniques were then used to sample teachers from five of the seven circuits with each circuit being allocated 62 teachers for the study. A semi-structured questionnaire which was used for the data collection was adapted from a study in Namibia. Chi squares and P-values were applied to determine the association between dependent and independent variables as confidence level set at 0.05. Data was analyzed with SPSS version 20.Results: The study found that majority of the teachers, 167 (73.9%) were knowledgeable about epilepsy and 191 (84.5%) had positive attitudes toward epilepsy. However, seizure management practices among the teachers were poor; only 44 (19.3%) of the teachers had appropriate seizure management practices. Notwithstanding, the religion of the teachers was found to be significantly associated with knowledge on epilepsy (p=0.041). The study found that marital status had an effect on attitudes toward epilepsy (p=0.004), whilst educational qualification was also significantly associated with attitudes toward epilepsy (p=0.001). The self-rated knowledge levels of the teachers, had no significant relationship with seizure management practices (p=0.508).Conclusion: Though majority of the teachers had adequate knowledge and positive attitudes toward epilepsy, it did not reflect in appropriate management of seizure.Recommendation: The Ghana Health Service should collaborate with the Ghana Education Service in training teachers on the management of seizure attacks.

Epilepsy Treatment Outcome and Its Predictors among Ambulatory Patients with Epilepsy at Mizan-Tepi University Teaching Hospital, Southwest Ethiopia

Background. Epilepsy is among the most common neurological disorders which is highly treatable with currently available antiepileptic drugs at a reasonable price. In Ethiopia, despite a number of studies revealed high prevalence of epilepsy, little is known on predictors of poorly controlled seizures. Thus, the aim of this study was to assess epilepsy treatment outcome and its predictors among patients with epilepsy on follow-up at the ambulatory care unit of Mizan-Tepi University Teaching Hospital, Southwest Ethiopia. Methods. A hospital-based cross-sectional study involving patient interview and chart review was conducted from March 10 to April 10, 2018. Drug use patterns and sociodemographic data of the study participants were accustomed to descriptive statistics. Backward logistic regression analysis was done to identify predictors of poor seizure control. Statistical significance was considered at p value <0.05. Results. From a total of 143 studied patients with epilepsy, 60.8% had uncontrolled seizures. Monotherapy (79%) was commonly used for the treatment of seizures, of which phenobarbital was the most commonly utilized single anticonvulsant drug (62.9%). The majority (72.7%) of the patients had developed one or more antiepileptic-related adverse effects. Medium medication adherence (adjusted odds ratio (AOR) = 5.4; 95% CI = 1.52–19.23; p=0.009), poor medication adherence (AOR = 8.16; 95% CI = 3.04–21.90; p=0.001), head injury before seizure occurrence (AOR = 4.9; 95% CI = 1.25–19.27; p=0.02), and seizure attacks ≥4 episodes/week before AEDs initiation (AOR = 8.52; % CI = 2.41–13.45; p=0.001) were the predictors of uncontrolled seizure. Conclusions. Based on our findings, more than half of the patients with epilepsy had poorly controlled seizures. Nonadherence to antiepileptic drugs, high frequency of seizure attack before AEDs initiation, and history of a head injury before the occurrence of seizure were predictors of uncontrolled seizure. Patient medication adherence should be increased by the free access of antiepileptic drugs and attention should be given for the patients with a history of head injury and high frequency of seizure attacks before AEDs initiation.