Epilepsy in patients 60 years and above

To evaluate the clinical characteristics and etiology of epilepsy at age 60 years and above in the Western Region of Saudi Arabia [KSA], as epilepsy is now considered to be the third most frequent neurological problem in the elderly population. We retrospectively reviewed the medical records of patients 60 years and above at King Khalid National Guard Hospital, Jeddah, KSA between 1999 and 2007 with new onset of seizures and diagnosed as suffering from epilepsy. We excluded patients 60 and above with provoked seizures. Seventy-five patients of late onset epilepsy were studied. Partial seizure [focal] was found in 40 patients [53.3%]; generalized tonic clonic seizures in 18 patients [24%]; unclassified seizure in 13 patients [17.5%]; and status epilepticus in 4 patients [5.3%]. Stroke was the underlying etiology in 52 patients [69.3%]; brain tumor was found in 8 patients [10.7%], trauma in 3 patients [4%], and infection in 3 patients [4%]. None of the patients had a family history of epilepsy. No cause [idiopathic] was found in 9 [12%] patients. The most common type of epilepsy at age 60 and above in our study is symptomatic epilepsy with stroke as the leading cause. Modifying risk factors for stroke such as: hypertension, diabetes mellitus, and high cholesterol may reduce the incidence of epilepsy in this age group

Idiopathic intracranial hypertension. Atypical presentation

To describe the clinical features of 5 patients with rare atypical presentation of idiopathic intracranial hypertension [IIH], and propose the possible mechanism of this atypical presentation. We carried out a retrospective study of 5 patients admitted at King Khalid National Guard Hospital, Jeddah, Kingdom of Saudi Arabia with IIH during the period from January 2001 to December 2005. All were females with their age ranges from 24 to 40 years. The clinical presentations, and the laboratory and imaging studies were analyzed. The opening pressures of the lumbar puncture tests were documented. All patients were presented with headache. One had typical pain of trigeminal neuralgia, and one with neck pain and radiculopathy. Facial diplegia was present in one patient, and 2 patients had bilateral 6th cranial neuropathy. Papilledema was present in all patients except in one patient. Imaging study was normal in all patients, and they had a very high opening pressure during lumbar puncture, except in one patient. All patients achieved full recovery with medical therapy in 6 to 12 weeks with no relapse during the mean follow up of 2 years. Atypical findings in IIH are rare and require a high index of suspicion for early diagnosis

Osteomalacic Myopathy due to celiac disease

Celiac disease is a gluten-sensitive enteropathy characterized by malabsorption resulting from inflammatory injury to the mucosa of the small intestine. It is well known to be associated with a variety of neurological disorders including epilepsy, myopathy, neuropathy and ataxia. The nature of this association is unclear. Although osteomalacia secondary to vitamin D deficiency is a recognized complication of celiac disease, however, severe osteomalacic myopathy as the only presentation of celiac disease is extremely rare. We present 2 interesting cases of osteomalacic myopathy secondary to celiac disease, which were treated successfully with full recovery. An important and unique observation was the brisk reflexes noticed in both patients. The mechanism behind this phenomenon is not well understood. Work-up for celiac disease is warranted in any young patient that presents with myopathy