Patients' preferences towards antiepileptic drug therapy following first attack of seizure.

BACKGROUND: Antiepileptic drug (AED) therapy following first unprovoked seizure is controversial. AIM: To study the patients' preferences towards AED therapy following first unprovoked generalized tonic clonic seizure (GTCS). DESIGN: Prospective cohorts with one year follow-up study. SETTING: Government teaching hospital, a tertiary care center. MATERIALS AND METHODS: Patient cohort included patients with first attack of unprovoked GTCS within 30 days of onset, aged between 18-60 years and with normal brain CT scan. Counseling was done for all the patients and the relatives regarding seizure recurrence, duration and adverse effects of AED therapy if preferred. Patients were encouraged to make their own decision in preferring or deferring AED with reasons. They were followed up for one year. RESULTS: Of the 73 enrolled (54 males and 19 females) 39 (53%) preferred to go on AED therapy. The reasons for preferring AED therapy were; (a) fear of seizure recurrence, 21 (54%); (b) risky occupation, 14 (36%); and (c) fear of injury, 4 (10%). The reasons for deferring were: (a) fear of adverse effects of long-term AED therapy, 19 (56%) and (b) preferring to wait for the second attack, 15 (44%). All the patients were happy about being involved in the decision-making. CONCLUSION: Following first attack of unprovoked GTCS the decision regarding AED therapy may be taken by the patients and their family members after adequate counseling and such decisions have more relevance from their perspective.

Physical growth and psychomotor development of infants exposed to antiepileptic drugs in utero.

OBJECTIVE: To evaluates the physical growth and psychomotor development of infants born to women with epilepsy on regular Anti Epileptic Drugs (AEDs). SETTING: Govt. Stanley Medical College and Hospital, Tertiary care referral centre, Chennai. DESIGN: Open prospective cohort study with a control group. MATERIALS AND METHODS: Consecutive women with epilepsy who were on regular anticonvulsants were followed up from their first trimester. Their babies were examined at birth and anthropometric measurements including anterior fontanelle size were noted. They were followed up till one year and periodically evaluated at 1st, 6th and 12th month of age. Development testing using Griffith scale was done at 2nd, 6th and 12th month. An equal number of control babies were also studied using the same scale for one year at the specified intervals. The results in both the groups were compared. RESULTS: 30 babies were enrolled in the case and control group. The AEDs received by the mothers with epilepsy were Phenytoin, Carbamazepine, and Sodium valproate. At birth and 1st month the weight, head circumference and length of case and control babies were equal. At 6th and 12th month reduction in the above 3 parameters were noted in the case babies ( P < 0.01). Area of anterior fontanelle (AF) was larger in the study group particularly in those exposed to phenytoin in utero (P < 0.001). In the case babies reduction in the sitting, prone and erect progression of the locomotor scores was observed at 2nd month (P < 0.001). Prone progression alone improved by 12th month and other two remained less than the control (P < 0.001). No difference was observed in reaching behaviour and personal/social scores in both groups. Infants exposed to Phenytoin monotherapy had a negative impact on sitting progression. CONCLUSION: Among infants exposed to AEDs in utero physical growth was equal to that of control at birth but reduced at 6th and 12th month probably due to extraneous factors. The Locomotor scores showed reduction in all areas in 2nd, 6th and 12th month except prone progression which alone improved by 12th month. Phenytoin exposure in utero resulted in large AF and it had a negative impact on sitting progression in comparison with Carbamazepine and Sodium valproate.

Effect of combined supplementation of fish oil with garlic pearls on the serum lipid profile in hypercholesterolemic subjects.

BACKGROUND: Elevated total cholesterol, especially low-density lipoprotein has been documented as the leading risk factor for the coronary artery disease among Indians. Studies with fish oil supplementation alone have shown an increase in low-density lipoprotein, thereby enhancing the risk associated with incidence of coronary artery disease in hypercholesterolemic subjects. In view of this, the effect of a combined supplementation of fish oil with garlic pearls on the serum lipid profile of hypercholesterolemic subjects was studied. METHODS AND RESULTS: We administered 600 mg of fish oil with 500 mg of garlic pearls (garlic oil) per day to 16 hypercholesterolemic subjects (age range: 30-60 years) with a total cholesterol above 220 mg/dl for 60 days. The effect of this combined supplementation was compared with that of a control group (16 hypercholesterolemic subjects) without any supplementation. The baseline body height and weight of all the subjects were recorded. Significant reductions were seen in all the lipid parameters (except high-density lipoprotein which was increased) in the test group after 60 days compared to that of the control group. The total cholesterol, low-density lipoprotein, serum triglyceride, very low-density lipoprotein, and the total cholesterol: high-density lipoprotein ratio reduced by 20%, 21%, 37%, 36.7%, and 23.4%, respectively, and the high-density lipoprotein increased by 5.1% after 60 days of supplementation. CONCLUSIONS: The co-administration of garlic pearls with fish oil was found to be more effective than placebo in the management of dyslipidemia.

Nonepileptic attack disorder among married women.

AIM: To study the clinical features, precipitating stressful life events and prognosis of nonepileptic attack disorder (NEAD) among married women. DESIGN: Prospective cohort study with 1-year follow-up. SETTING: A tertiary care teaching hospital. SUBJECTS: Of the 1020 patients with epilepsy referred to the epilepsy clinic during 2002-2003, 30 were married women with NEAD. MATERIALS AND METHODS: The diagnostic criteria for NEAD included normal EEG during ictal and post-ictal phase of the generalized 'attack.' The data collected included clinical characteristics, semiology of the attacks, precipitating stressful events, and co-morbid psychiatric disorders. The control group included 30 age-matched married women with generalized tonic-clonic seizures. The long-term outcome and factors influencing the outcomes were analyzed. RESULTS: The mean duration of illness was 18 months, and the pattern of the attack was 'fall and lying still' in 53% and 'fall with generalized motor movements' in 47%. The frequency was one or more per week in 57% and occasionally in 43%. The important stressful events were matrimonial discord following illegal relationship of the husband with another woman (chi2 = 9.02, P = 0.003) and constant quarrel with other family members (chi2 = 5.19, P = 0.02). The prevalence of sexual abuse was low (7%). Co-morbid psychiatric disorder was observed in 70%. At the end of 1 year, 39% were free from the attack. Resolution of the stressful life events (chi2 = 4.52, P = 0.03) and lower frequency of attack at the time of reporting (chi2 = 3.88, P = 0.05) correlated with good outcomes. CONCLUSION: Among patients with NEAD in India, the major precipitating factors were matrimonial discord following illegal relationship of the husband with another woman and constant quarrel with other family members and not sexual abuse. Women with low frequency of attack at the time of reporting and the remission of the stressful events had better outcomes.