Descending Cephalic to Epigastric Sensation in a Patient with Mesial Temporal Lobe Epilepsy: A Novel Observation

One of the most frequent type of auras in mesial temporal lobe epilepsy (MTLE) is epigastric sensation. Until now the site of the symptomatogenic zone of the epigastric aura remains controversial. The temporal lobe as well as insular cortex has been implicated. Our case is that of a 29-year-old young woman who presented with an aura of descending cephalic to epigastric sensation as opposed to the prototypical ascending aura. Interictal and ictal recording favored a mesial temporal pattern. Magnetic resonance imaging brain showed left mesial temporal lobe sclerosis. Interictal positron emission tomography showed concordant findings. The patient underwent selective amygdalohippocampectomy following which she remains seizure-free. This previously unreported clinical expression of MTLE and its origins is discussed.

Association of Psychiatric Disorders in Children and Adolescents with Epilepsy in a Tertiary Care Hospital in Bangladesh

Background Psychiatric disorders are important aspects of epilepsy and have received increasing attention in the last several years. Although a significant number of children are afflicted with epilepsy with psychiatric comorbidities, the actual burden was not evaluated sufficiently. Objective To determine the types and frequency of psychiatric disorders in children with epilepsy. Materials and Methods This hospital-based case-control study was conducted at the outpatient department of a tertiary care center in Dhaka, Bangladesh, from September 2018 to August 2019. In total, 68 epileptic children, ranging from 5 to 17 years of age, were enrolled as cases. A similar number of nonepileptic children of age, sex, and sociodemographic status matched were enrolled as control. Parent, teacher, and self-version of Bengali Development and Well-Being Assessment (DAWBA) were used to assess the psychiatric disorders, and the diagnosis was assigned as Diagnostic and Statistical Manual (DSM)-V of Mental Disorders. Results Higher proportion of psychiatric illness were found significantly among the cases (83.8% vs. 16.2%; p < 0.001) and broad categories of disorders, namely, neurodevelopmental (30.9% vs. 1.5%, p < 0.001), emotional (48.5% vs. 7.4%, p < 0.001) and behavioral disorder (19.1% vs. 7.4%, p = 0.043) compared with controls. There was a significant relationship between psychiatric disorders with the duration of epilepsy of the respondents (p = 0.032). Conclusions This study result showed the significant association of psychiatric disorders with epilepsy among children and adolescent population. Thus, psychiatric disorders should be properly addressed during treatment of epilepsy.

Perception about Etiology of Epilepsy and Help-Seeking Behavior in Patients with Epilepsy

Objectives Patients with epilepsy and their family have diverse beliefs about the cause of their illness that generally determine their treatment-seeking behavior. In this study, our aim was to find out different beliefs about epilepsy that lead to different help-seeking patterns, which act as barrier to the intended modern medical management of epilepsy. Materials and Methods One hundred and fifty consecutive consenting patients accompanied by a reliable informant/family member fulfilling the International Classification of Epileptic Seizures (ICES), simplified version, were included. Demographic and clinical data of all the eligible subjects was collected. Perceived cause of illness and help-seeking pattern were explored from patient/informant by administering proper instruments. Results Respondents identified varied causes of epilepsy and explored multiple help-seeking options before reaching tertiary care centers. We observed that, generally, epileptic patients/relatives who had belief in causes like supernatural causes sought help from nonprofessional personnel and those attributed their symptom to bodily pathology had professional help-seeking. Conclusions The belief in supernatural causes not being conformed to the biomedical models of the epileptic disorders increases the treatment gap.

Long-Term Seizures Outcome in Juvenile Myoclonic Epilepsy (JME): A Retrospective Cohort Study in an Indian Population

Objectives Juvenile myoclonic epilepsy (JME) is the most prevalent form of generalized epilepsy in the community. Though the response to medication is good in most patients, long-term medication usage may lead to poor compliance, side effects, and other epilepsy-related social issues. The aim of this study was to describe the demography, clinical features, and therapeutic response in patients with JME who have had at least 10 years of duration of epilepsy. Materials and Methods A retrospective study of 56 patients (M:F=26:30; mean age: 14.5 ± 5.1 years) with JME attending neurological services in a tertiary care neurological center in South India with more than 10 years disease duration was performed. Results All patients had myoclonic jerks, 94% had generalized tonic–clonic seizure, and only 7.1% had features of absence seizures. Seizures were controlled in 60% of cases at the end of 10 years of epilepsy. Thirty-eight patients (67.8%) were on valproate. Control of seizures at the end of the first and fifth years of epilepsy, frequent myoclonic jerks at the onset, and treatment with valproate in the first year of disease resulted in controlled seizures at the end of 10 years. No patient was off medications at the end of 10 years of epilepsy or at the last follow-up. Conclusion About 40% of our patients continued to have seizures even 10 years after the onset of epilepsy. Regular and long-term medication may be required in JME. Early control of seizures, response to valproate, and frequent myoclonia at onset were found to confer better prognosis.

Validation of the New International League Against Epilepsy (ILAE) 2017 Classification for Determining Seizure Type in Indian Patients

Introduction Epilepsy is a common condition in neurology comprising several electroclinical syndromes and seizure disorders of varying known and unknown etiologies that require variable diagnostic workup, treatment, and have obviously different prognoses. Therefore, for appropriate patient management, the best possible classification system for epilepsy is required. The International League Against Epilepsy (ILAE) is continuously working on this with the latest classification provided in 2017. There is little knowledge about seizure type based on newer classification systems in Indian patients. Aims and Objective To test the applicability of the newer ILAE 2017 classification of epilepsy in determining seizure type in Indian patients, with respect to right patient management, the best classification system for epilepsy is necessary. Materials and Methods Prospective data of 310 consecutive patients with seizures presenting in neurology department was collected from December 2017 to June 2018 and analyzed according to the newer systems of classification of seizures proposed by ILAE in 2017. Results All 310 patients in age ranging from one year to 72 years with seizures could be classified according to the ILAE 2017 classification system. Focal onset seizure was noted in 66 patients (21.3%), while 244 patients (78.7%) had generalized onset based on clinical onset of seizure. Awareness was impaired in 262 (84.5%) patients. Motor onset seizure was observed in 278 patients (89.6%), while nonmotor seizure included absence, sensory, cognitive, and autonomic seizures. Conclusion The present study showed that all patients could be classified using ILAE 2017 classification system. Majority of seizure were generalized onset, predominantly motor type of seizure with impaired awareness using clinical description of classifying seizure, while focal onset seizure was the majority type of seizure when ancillary information was considered.

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.

Depression in Patients with Epilepsy in Nigeria: Phenomenology and Predictors

Objectives To determine the correlates of depression among patients with epilepsy in Neuropsychiatric Hospital, Aro, Abeokuta, Nigeria. Methods 270 patients with epilepsy attending the outpatient clinic of the hospital were recruited and assessed using sociodemographic questionnaire, MINI-Plus, and BDI-II. Results The mean (standard deviation [SD]) age of the respondents was 32 (9.9) years, 45.6% were females, and 38.5% were married. Thirty-two (11.9%) patients had a diagnosis of major depressive disorder (MDD) and 13 (4.8%) had a diagnosis of dysthymia. The most common depressive symptoms were loss of pleasure (84.4%), crying (84.4%), self-dislike (81.3%), and loss of energy, tiredness/fatigue, indecisiveness and punishment feelings (78.1% each). Vegetative symptoms such as changes in appetite and sleep and loss of interest in sex were the least common depressive symptoms. In the logistic regression, seizure frequency was the single predictor of MDD and dysthymia. Patients who had at least one seizure per week were five times more likely to develop MDD (OR = 5.1, p = 0.014) and 16 times likely to have dysthymia (OR= 16.0, p = 0.0007). Patients who had at least one seizure per month were 3 times more likely to develop MDD (OR = 3.3, p = 0.029). Conclusion Seizure frequency is an independent predictor of depression among patients with epilepsy. Patients with poor seizure control are at higher risk of developing depression and should be routinely screened for depression.

Quality of Life Assessment in Pediatric Epilepsy

Quality of life (QOL) is an accepted health outcome measure in clinical practice. This study was performed to assess QOL in pediatric epilepsy patients and identify demographic and clinical factors influencing it.A cross-sectional study was conducted in the outpatient pediatric department of Dhulikhel Hospital, a tertiary care teaching hospital of Nepal. Parents or caretakers of children receiving one or more antiepileptic drugs were interviewed using QOL childhood epilepsy questionnaire comprising 91 items with seven domains and 16 subscales.All the individual subscales of the questionnaire were found to be compromised with least score on QOL and general health item. Compromised social, physical, psychological, emotional, cognitive as well as behavioral domains were also identified. QOL was found to be effective more in older children and in those from rural areas. They had significant linguistic impairment and lower level of self-esteem. Overall QOL was found to be compromised more in patients with generalized than with focal epilepsy. Seizure frequency and polytherapy were the factors compromising overall QOL.Despite taking appropriate antiepileptic drugs, epilepsy was found to be detrimental to QOL of patients. Hence, QOL assessment should be an important part of epilepsy management protocol.