aspect of epilepsy not to be ignored

Stigma is considered to be one of the most important factors that have a negative influence on people with epilepsy [PWE] and their families. It is a global issue commonly encountered in PWE in all cultures. Stigma may have deleterious effects on the patient's life, more than epilepsy itself. It is the duty of all health professionals to try and improve the quality of life of PWE beyond seizures control, and one of the important ways to do so is by fighting stigma. Many different health professionals including physicians, surgeons, social workers, psychologists, psychiatrists, and nurses deal with PWE, and hence stigma in PWE can be encountered and dealt with by many diverse specialties. Unfortunately, this issue is addressed primarily in specialized journals like Epilepsia, Epilepsy and Behavior, Seizure, and Social Science Medicine. Professionals interested mainly in epileptology or social sciences read such journals, and we feel that this issue should be addressed in a journal targeting readers of different specialties and interests

Papilledema without lateralizing signs

The cases of 40 patients [ages, 18-40 y] who presented with papilledema without lateralizing sings [PWLS] were analyzed retrospectively, with particular reference to the underlying causes. Benign intracranial hypertension and pseudotumor cerebri were the most common causes and dural sinus thrombosis was the next most common. Benign intracranial hypertension was more prevalent among women [25 females versus one male] and dural sinus thrombosis was more prevalent among men [seven males versus two females]. Space-occupying lesions were the least common cause. Males presenting with PWLS and females lacking the risk factors for benign intracranial hypertension should undergo digital subtraction angiography and be followed regularly to rule out any underlying structural disorder before a diagnosis of benign intracerebral hypertension can be made

Malignant hyperthermia, neuroleptic malignant syndrome and heat stroke: spectrum of a clinical syndrome

Malignant hyperthermia [MH] is a rare disease which occurs in genetically susceptible subjects after exposure to certain anaesthetics. The triggering anaesthetic agent causes abnormal release or re-uptake of calcium Ca[2+] from the sarcoplasmic reticulum. This interferes with the contraction relaxation process with a progressive increase in heat production and reduction of ATP levels. Neuroleptic malignant syndrome [NMS] is an uncommon disorder and occurs after administration of a neuroleptic agent or acute withdrawal of dopamine therapy. This leads to reduced central dopaminergic drive in the striatum and hypothalamus, so, extrapyramidal muscle rigidity with progressive generation of heat occurs. Heat stroke [HS] is due to the transfer of heat from the environment to the body core. This leads to a major insult to the hypothalamus, the temperature thermostat of the body, so there is a progressive increase in body temperature. There are similarities in the pathogenesis, biochemical changes, clinical pictures, complications and accordingly, the management of these potentially fatal syndromes. Dopaminergic agents and bromocriptine are effective in NMS but of no use in MH or HS. Dantrolene, an inhibitor of calcium release from the sarcoplasmic reticulum is the specific treatment for MH. It has also been used successfully in NMS and HS especially if rhabdomyolysis has occurred

neuroleptic malignant syndrome

The neurolptic malignant syndrome is a rare serious idiosyncratic reaction to neuroleptic drugs. It is characterized by muscular rigidity, fever, altered consciousness, autonomic dysfunction, elevated level of creatine kinas, and leukocytosis. It has a universal occurrence, but has not been reported from the Arab countries to the best of our knowledge. We describe three cases from Saudi Arabia and review the literature for possible risk factors in this potentially fatal condition