Seizure characteristics in patients with seizure attacks, visited in neurology emergency unit of Ghaem Hospital [2002-2003]

As a common symptom of brain diseases, seizure often indicates severe brain tissue involvement. The purpose of this study was to evaluate the different etiologies of seizure disorders. In this descriptive study, from Marches 2002 to February 2003 497 epileptic patients in Neurology Emergency Unit of Ghaem Hospital, Mashhad were studied. Routine laboratory tests, EEG, and brain CT-Scan was performed for all patients and brain MRI was done for some of them. Demographic data and results of laboratory tests, EEGs and brain CT-Scans were recorded in specific data collection sheets and were analyzed by SPSS software. In our patients [497 cases], 51.3% were male and the others [48.7%] were female. The mean age of our population was 37.6 years and most of patients were middle aged [35-60 years]. The prevalence of different seizures was as follows: Generalized seizures in 82.8%, Focal seizures in 7.5%, and focal seizures with secondary generalization in 9.7%. The prevalence of different etiologies of seizures was: idiopathic and cryptogenic in 48.5%, cerebral vascular diseases in 13.5%, brain tumors [primary or metastatic] in 6.8%, trauma in 6%, acquired metabolic diseases in 6%, drug intoxication or withdrawal in 4.8%, brain infections in 4.6%, developmental disorders in 2.6%, collagen vascular diseases in 2.2%, hypoxic-ischemic encephalopathy in 1.8%, phakomatosis in 0.8%, degenerative disorders in 0.8%, hypertensive encephalopathy in 0.6%, demyelinating diseases in 0.6%, and eclampsia in 0.2%. 65.85 of our patients had a previous history of at least one seizure attack, 25.25 had experienced their first seizure and 9.1% had been admitted because of status epilepticus. 15.3% of patients had positive family history for epilepsy. The most common cause of epilepsy in this study was idiopathic and cryptogenic and cerebral vascular diseases and tumors were the next common causes. Being so common as a cause of seizure and having significant morbidity and mortality, cerebral vascular diseases and brain tumors should be prevented or treated vigorously. Besides, recurrence of seizure attacks as the result of inappropriate drug intake or insufficient drug dose draws particular concern

[Evaluation of charactristics and outcome of treatment of reflex epilepsy]

Reflex epilepsy is a disorder, in which seizure attacks are induced by an external stimulus or, rarely, by a mental activity. The attacks in this disorder are usually provoked just in response to a specific stimulus and patients with this disorder have no unprovoked ictal event in most instances. This research was designed to study different reflex epilepsies and their appropriate managements. This descriptive study was done by evaluating the medical files of 9676 patients with the diagnosis of epilepsy, visited in a 10-year period [1996-2006] in Dr. Nikkhah Clinic. 33 of them with the final diagnosis of reflex epilepsy were selected. The data [such as, types of seizure, type of stimulus, electroencephalographic findings, and therapeutic strategy] was recorded for each patient in questionnaire and analyzed by appropriate descriptive statistics and frequency distribution tables. In the study population, 15 females and 18 males with reflex epilepsy, seizure attacks had been provoked by the following stimuli: visual stimuli in 21[63.6%] patients, chewing in 4[12%] patients, mathematical calculating processes in 3 [9%] patients, micturation in 3 [9%] patients, playing chess in one[3%] patient, and warm bathing in another one [3%] patient. Brain CT scan was normal in all of our patients. Seizure attacks were eliminated in 6 patients with visual-evoked reflex epilepsy after cessation of visual stimuli. Being unable to eliminate the stimulant factor, we started antiepileptic drugs for other patients. 90% of these patients have been seizure- free just with sodium valproate. In a suspected patient whose attacks are related to a specific stimulus, the practitioner should consider the nature and properties of stimulant precisely. The treatment consists of prevention from and elimination of stimulant, and pharmacological managements

[Clinical and para clinical evaluation of peripheral nerves in patients with HTLV1 associated myelopathy]

The main neurological manifestation of Human T-cell Lymphotropic Virus type 1 [HTLV-1] is spastic Paraparesis, of progressive nature, also known as HTLV-1 Associated Myelopathy [HAM] or Tropical Spastic Paraparesis [TSP]. Despite various CNS complications described in HAM/TSP a relatively little attention has been directed toward disorders of the peripheral nervous system [PNS]. The aim of this study was evaluation of HAM/TSP patients about concomitant neuropathy by clinical and neurophysiologic methods. In this descriptive Study 73 Patients with HTLV1 associated myelopathy in Neurology Clinic of Ghaem Hospital were assesed by clinical and neorophysiologic evaluations in 2002-2004. Questionnaire was completed for each patient, and then Median and Ulnar nerves from the upper extremity and Proneal, Tibial and Sural nerves from the lower extremity were evaluated by electrophysiological studies [NCV]. Data was analyzed using descriptive statistics and frequency distribution tables. 65.8% of patients were clinically suspected to neuropathy. In 54.8% of patients with HAM/TSP, there was concomitant peripheral nerve disease. Mononeuropathy in 15 [20.54%], multiplex mononeuropathy in 5 [6.8%], motor sensory polyneuropathy in 17 [23.3%], motor polyneuropathy in 2 [2.7%] and sensory polyneuropathy in 2[2.7%] of patients were present. According to this study electrophysiological compromise of the peripheral nerve is frequent in patients with HTLV-1 associated myelopathy. Furthermore, electrophysiological compromise could arise even when the patient did not present clinical manifestations denoting this kind of problem. Hence, the study of nerve conduction has to become a routine test for patients with HAM/TSP

[Isolated nuclear oculmotor nerve syndrome due to mesencephalic hemorrhage Report of case]

Nilateral third nerve plasy with bilateral superior rectus paresis and bilateral ptosis is a typical condition for nuclear oculomotor nerve syndrome. In these patients, other neurological examination is normal. We report a rare case nuclear oculomotor nerve syndrome due to midbrain hemorrhage. As a rare cause of intracranial hemorrhage A 59-year-old man presented with an abrupt onset of ptosis and difficulty opening his eyes. He had uncontrolled hypertension in his history. Neurological examination revealed left oculomotor palsy with impairment of bilateral upward gaze and bilateral ptosis. CT scan showed mesencephalic hematoma in superior and left area. It is emphasized that isolated mesencephalic hemorrhage may be the cause of the nuclear oculomotor nerve syndrome without of other associated neurological signs

Single fiber electromyography in myasthenia gravis diagnosis

Introduction: Single fiber electromyography [SFEMG] is the most efficient way of neuromuscular junction disorders diagnosis. By this method action potentials of two adjacent fibers from the same motor unit can be recorded by using a bipolar electrode after voluntary activation or electrical stimulation of the nerve. The variability of the interpotential interval [IPI] between two single muscle fiber action potentials belonging to the same motor unit during successive discharge is referred to JITTER, that is expressed by the mean value of consecutive difference [MCD] quantity. The fiber density of each motor unit is also measure by same electrode

Material and Method: In this study that was carried out on 25 patients referred to mashhad ghaem Hospital with suspected diagnosis of myasthenia gravis [MG], SFEMG Test accomplished by voluntary contraction of extensor digitorum communis [EDC] and frontalis muscles, tensilon test and repetetive stimulation test [RST] was done simultaneously

Result:10 patients [40%] had generalized, 5 patients [20%] had bulbar and 10 patients [40%] had ocular symptoms of myasthenia gravis. SFEMG results in 3 patients suspected to ocular form, was negative. In these patients, myasthenia was also excluded in later evaluationes. SFEMG test was positive in the other patients [100%]

Conclusion: These results suggest that SFEMG for the diagnosis of myasthenia gravis, especially ocular type has more sensitivity and higher reliability than the other diagnostic methodes. It has not yet been feasible to use SFEMG as routine test for diagnosis of myasthenia gravis disease when other diagnostic tests were positive specially in generalized form, considering it is time consuming,costly and not having enough experience