ABSTRACT
Introduction. Traumatic brain injury (TBI) account for 20% of the symptomatic epilepsies in general population. Post traumatic epilepsy (PTE) may be presented with various clinical manifestations of seizure and clinical course of illness varies as well. The incidence of PTE varies with the time period after injury and the population age range under study, as well as the spectrum of severity of the inciting injuries ranges from 4% to 53%. In this study, we aimed to describe clinical characteristics and course of illness of patients with PTE.Materials and Methods. This hospital-based descriptive study was done 2012-2013 in Ulaanbaatar city. We retrospectively obtained number of patients with PTE reported in 2011-2012 from statistical reports of the National Health Center. In this study 109 patients with PTE, aged 16-72 were involved wrom which we collected detailed information on socio-demographic characteristics, history of illness, clinical manifestations including features of seizure and course of illness through pre-developed questionnaire. Medical examination was conducted after the interview to evaluate the seizures in accordance with semiological classification of epileptic seizures and the international classification International Leaque Against Epilepsy. Frequencies of variables including socio-demographic, clinical characteristics and clinical manifestations and, association between type of TBI and clinical manifestations were calculated. Correlation between diagnostic tests and clinical outcomes were also tested. Statistical analysis was conducted using SPSS 17.0 program. Ethical approval was obtained from the Ethical Committee of the School of Medicine, HSUM. Each participant had signed a consent form before involving in the study.Results. 81 (74.3%) participants of 109 were men and 28 (25.3%) were woman. Off our study participants, 98 (90%) were sufferng from generalized tonic clonic seizures. Off all participants, 43 (53.1%) males and 14 (50%) females presented moderate TBI. The mean duration of PTE is 9.6+-9.3 years, participants suffer from PTE 0-5 year. Of all, 19 (23.5%) males have a seizure once a week, 9(32.1%) female have seizure once a month. There were some differences in the forms of brain injury depending from gender; 57(70.4%) of males and 19(67.9%) of females had brain contusion. Only 5 (6.3%) of males had brain concussion, whereas for 6 (22.2%) females had this symptom. For males, intracranial hematoma accounted in 14 (17.7%), but for females in 2 (7.4%). Significant association was observed between clinical form of TBI and duration of loss of consciousness after the injury and injury severity (p<0.002). Of all, 21(19.3%) patients who had TBI were treated surgically. Its occurrence was positively correlated with early onset seizures (P<0.05). The frequency of seizure was not correlated with the structural brain abnormalities, but there was inverse association between frequency of seizure and duration of PTE (r= -0.32, p<0.001). As PTE continues longer the frequency of seizures decreases. Conclusion: Patients particularly surgically treated are suffer from PTE which is presented by generalized seizure. Patients with brain contusion, compression seem to be prone to post traumatic epilepsy. The course of PTE characterized long duration with high frequency of seizure, short time following by severe brain injury.
ABSTRACT
Complete seizure control is the single most important determinant of good quality of life for patients with epilepsy and the chronic nature of the disorder requires that antiepileptic drugs (AEDs) be administered for many years, often for a lifetime. Therefore, long-term experience is of particular importance in evaluating the efficacy and safety of an AED. Valproic acid increases γ-aminobutyric acid (GABA) synthesis and release and potentiates GABAergic transmission in specific brain regions and it also has also been found to reduce the release of the excitatory amino acid β-hydroxybutyric acid and to attenuate neuronal excitation mediated by activation of N-methyl-D-aspartate (NMDA) glutamate receptors. In addition to these effects, valproic acid exerts direct actions on excitable membranes, including blockade of voltage-dependent sodium channels. Valproate is generally regarded as a first-choice agent for most forms of idiopathic and symptomatic generalised epilepsies. Many of these syndromes are associated with multiple seizure types, including tonic-clonic, myoclonic and absence seizures, and prescription of a broad-spectrum drug such as valproate has clear advantages in this situation. The elimination half-life is in the order of 9 to 18 hours, but shorter values (5 to 12 hours) are observed in patients comedicated with enzymeinducing agents such as phenytoin, carbamazepine and barbiturates. The most commonly reported adverse effects of valproate include gastrointestinal disturbances, tremor and bodyweight gain. Other notable adverse effects include encephalopathy symptoms (at times associated with hyperammonaemia), platelet disorders, pancreatitis, liver toxicity and teratogenicity. According to the some study results, endocrine manifestations of reproductive system disorders, including polycystic ovary syndrome, may be more common in women treated with valproate than in those treated with other AEDs.