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Background: Seizures are a common neurological disorder encountered globally in regular medical practice. Hospital onset seizures may occur in patients who never had a history of seizure before hospitalization and may be due to causes that lead to hospitalization or acquired during hospitalization like stroke, neuro infection etc. The objectives of this study were the purpose of the present study was to study the incidence and to describe demographic and clinical characteristics of patients developing new onset seizures in an intensive care unit of a tertiary care hospital.Methods: A prospective study for two years was conducted on cases of seizures admitted in an intensive care unit of a tertiary care hospital. The etiology of all the cases was recorded based on the clinical history and necessary investigations like EEG and imaging studies of the brain in cases if required.Results: About 238 cases with males 177 and females 61 cases were enrolled, and 31-50 years was most common age group. Diabetes was the most common co morbidity associated and generalized seizures were most common. CVA was most common etiology (26.89%) and idiopathic next common. Infarct was most common cause of CVA and meningitis in infections. Generalized tonic clonic seizures was most common in cases with CVA as the aetiology followed by infective cases.Conclusions: It is mandatory to deal cautiously and carefully the cases of seizures developing in an ICU in addition to proper history and examination, each patient must undergo detailed EEG, imaging investigations and other ancillary investigations if necessary.
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Background: Seizures are common in pediatric age group and less than 1/3rd of seizures in children are caused by epilepsy. Aim of present study was to analyze the etiological factors and clinical profile of new onset seizures in children aged 3-12 years.Methods: This was a prospective study done at a tertiary care center of south India. Authors analyzed 98 children aged 3-12 years presenting with new onset seizures. Proper history and investigations including EEG, and CT brain were done to confirm the etiology.Results: Out of 98 children 51 were 3-5 yrs of age and 47 were 6-12 years. 66.3% had generalized seizure and 33.6% had partial seizure. Partial seizure were more common in 5-12 years of age. Intracranial infections were the leading cause (73/98) which included neurotuberculosis (26/73), NCC (20), bacterial meningitis (12), cerebral malaria (8) and viral encephalitis (7). Intracranial infections' were the' leading cause in both age groups. Space occupying lesions were more common in 6-12 years (46.8%) as compared to 3-5 years (19.6%). NCC and Tuberculoma were the leading CT findings in both age groups. There was significantly high incidence of focal EEG changes in partial seizure group compared to generalized seizure group.Conclusions: Intracranial infections were leading cause of new onset seizures especially GTCS. Good clinical evaluation and judicious use of investigations should be ensured. CT brain and EEG are more likely to be informative in partial seizures than in generalized seizures.
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Cysticercosis is a common public health problem in the Tropics. One of the uncommon manifestations and a rare complication is its disseminated form (DCC). Here, we report a case of disseminated cysticercosis with history of generalized tonic clonic seizures for 2 years with characteristic MRI findings and biopsy evidence from para vertebral muscles.
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A variety of lymphoma types have been reported in patients being treated with anticonvulsant therapy. Non-Hodgkin lymphomas have been reported twice as frequently as Hodgkin lymphomas. Association of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) with dilantin therapy is extremely uncommon. We report a case of Hodgkin lymphoma in a 25-year-old male patient who had been treated with diphenylhydantoin sodium for generalized tonic clonic seizures for 15 years. Patient presented with left cervical and axillary lymphadenopathy persisting for more than 2 years after cessation of treatment with diphenylhydantoin. Computerized tomography scan of thorax, abdomen and pelvis revealed no signifi cant lymphadenopathy or any organomegaly. Diagnosis of NLPHL was made on excision biopsy of the cervical lymph node. Although the association between diphenylhydantoin therapy and the development of immunosuppression and lymphoma is well-documented, the role of the drug in the etiology of these disorders is still controversial.
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Objective: The current study was designed to analyze the extended efficacy and safety of Trioptal® (Oxcarbazepine) in treatment of children and adolescents with newly diagnosed partial seizures or generalized tonicclonic seizures in Indian population. Methods: This was an open-label non-randomized multi-centric observational prospective study (PMS study) across 54 centers in India. Treatment with Trioptal® (Oxcarbazepine) was initiated with a clinically effective dose (8-10 mg/kg/day in children) given in two divided doses as per the prescribing information. The dose was increased depending on the clinical response of the patient. In children, if clinically indicated, the dose was increased by a maximum of 10 mg/kg/day increments at approximately weekly intervals from the starting dose, to a maximum daily dose of 60 mg/kg/day. The efficacy of Trioptal® was assessed primarily by the percentage of seizure-free patients at 24 weeks. Secondary efficacy of the treatment was assessed through: reduction in seizure frequency at 24 weeks and the Global assessment of efficacy by the investigator at 24 weeks. Results: A total of 485 subjects were enrolled in the study. Majority of the subjects (52%) were stabilized at 8-15 mg/kg/day dose of Trioptal® and mean effective dose was 16.1 mg/kg/day (± 7.02). Approximately 70 % of the subjects were seizures free after 24 weeks of Trioptal® treatment and around 88% of the subjects reported the reduction in seizure of more than 50 %. The mean reduction in seizure frequency after 24 weeks of treatment was 82.3%. The overall efficacy with the Trioptal® treatment for 24 weeks was ‘good’ to ‘excellent’ in more than 97% of the subjects as per the assessment by the physician. A total of 59 adverse events were observed in 43 (8.9%) subjects. Headache was the most common adverse event being recorded in 8 subjects, followed by somnolence, nausea, vomiting, skin rash and weight gain. The overall tolerability of Trioptal® as per assessment by the patients was ‘good’ to ‘excellent’ in more than 98% of the subjects. Conclusion: Trioptal® (Oxcarbazepine) treatment is effective, safe and well tolerable in children and adolescents with newly diagnosed partial seizures or generalized tonic-clonic seizures.
Subject(s)
Adolescent , Carbamazepine/administration & dosage , Carbamazepine/adverse effects , Carbamazepine/analogs & derivatives , Carbamazepine/pharmacology , Child , Child, Preschool , Humans , Product Surveillance, Postmarketing , India , Seizures/classification , Seizures/diagnosis , Seizures/drug therapy , Seizures/epidemiology , Treatment OutcomeABSTRACT
Objective To investigate the neuropsychological characteristics of secondarily generalized tonic clonic seizures (SGTCS). Methods Twenty patients of SGTCS were divided into higher SGTCS group (the times of SGTCS ≥ 20,10 cases) and lower SGTCS group (the times of SGTCS < 20,10 cases). Investigated the tests of verbal intelligence quotient (VIQ), procedure intelligence quotient (PIQ) and full-scale intelligence quotient(FIQ), as well as cognitive test, BCRT-reaction time, CVST-reaction time and the deterioration scores. Results The VIQ, PIQ, FIQ and cognitive test of higher SGTCS group were significantly lower than those in lower SGTCS group[(94.9 ± 20.9) scores vs (116.0 ± 17.8) scores, (95.3 ±16.8) scores vs(117.8 ± 12.4) scores, (94.3 ±20.6) scores vs (118.0±12.8) scores, (14.1±4.9) scores vs (19.8 ± 2.1)scores] (P < 0.05 or < 0.01), and the outcomes of CYST-reaction time and the deterioration scores were significantly higher than those in lower SGTCS group [(16.6 ± 5.1) s vs (11.9 ± 2.0) s, (3.1 ± 1.4) scores vs(1.6 ± 1.1) scores](P < 0.05). Conclusion Intellectual and information gathering capability of SGTCS were deteriorated with the degree of disease worsened.
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INTRODUÇÃO: Pacientes com epilepsia generalizada primária (idiopática) podem, raramente, não responder ao tratamento medicamentoso e assim apresentar crises tônico-clônicas generalizadas (CTCG) recorrentes, incapacitantes e que colocam o paciente em risco de complicações graves. OBJETIVO: Nesse artigo é relatado o caso de um paciente com epilepsia generalizada primária e CTCG semanais, refratárias a diversos esquemas medicamentosos, que foi submetido a uma calosotomia. RESULTADO: No curto espaço de 3 meses de seguimento pós-operatório, o paciente não mais apresentou CTCG. CONCLUSÃO: A calosotomia pode ser um procedimento útil na redução da freqüência de CTCG refratárias, mesmo em pacientes com epilepsia generalizada primária.
INTRODUCTION: Patients with idiophatic generalized epilepsy (IGE) may occasionally have frequent generalized tonic-clonic seizures (GTCS) which are not adequantely controlled by antiepileptic drugs. Frequent GTCS pose a significant risk of injury and other complications. In symptomatic generalized epilepsies, corpus callosotomy (CC) has been shown to be effective in reducing the number of generalized seizures. OBJECTIVE: We report a patient with refractory, weekly GTCS in the context of a primary generalized epilepsy syndrome who underwent subtotal CC. RESULT: In the 3 months since operation, no GTCS occurred. CONCLUSION: Corpus callosotomy can be helpful in reducing medically-refractory GTCS, even in patients with primary generalized epilepsies.