Diagnosis of subclinical hepatic encephalopathy in patients with liver cirrhosis

In addition to clinically manifest hepatic encephalopathy, a subclinical stage has been described, This stage can be detected only by psychometric and/or neurophysiological tests. Early diagnosis and treatment of subclinical hepatic encephalopathy [SHE] may improve the daily functioning of the patients. We used two psychometric tests [Number Connection Test and Digit Symbol Test] and electroencephalography [EEG] to detect the prevalence of SHE in 200 patients with stable liver cirrhosis. One hundred age-matched healthy controls underwent the psychometric tests, while only 40 of them shared in the biochemical evaluation of the liver disease. Seventy-sex [38%] of the 200 patients, had SHE. SHE was diagnosed by the presence of at least one abnormal psychometric test and/or abnormal slowing of the EEG. Sixty-six [33%] of the 200 patients, had abnormal results on at least one psychometric test. Old age or low education may cause false positive psychometric tests. Sixty [30%] of the 200 patients, had slowing of their EEGs. A positive correlation was found between the severity of EEG slowing and the severity of liver disease and also the disease duration. It was noticed that some patients had only abnormal one psychometric test or only EEG slowing. This poor overlap between the different tools used for the diagnosis of SHE suggests that the use of a multiple psychometric test battery conjoined with neurophysiologic tests may lead to better and earlier diagnosis of SHE which appears to be prevalent among patients with stable cirrhosis

Intellectual impairment among epileptic children correlation with age of onset and duration of epilepsy

Intellectual impairment among epileptic children has been a subject of study throughout the modern era of epileptology. Early age of onset and long duration of epilepsy have been implicated as possible contributors. To test for this hyposis, 45 epileptic children and 20 normal controls of the same age group [6-16 years] were studied using Wechsler Intelligence Scale for Children Revised [WISC-R]. Correlations between intellectual impairment and age of onset and duration of epilepsy were done. The results showed that epileptic children have significantly lower IQ than controls. Moreover, those with earlier seizure onset and longer seizure duration have significantly lower IQ. In conclusion, the earlier the age of onset and the longer the duration of epilepsy, the more the intellectual impairment

Epilepsy following surgical excision of supratentorial neoplastic lesions

Thirty-six consecutive patients of supratentorial neoplasm surgery were evaluated and followed up for six months postoperatively to assess the incidence and causation of post-surgical epilepsy. All patients were subjected to careful history taking, full general and neurological examination. MRI and EEG were performed pre- and postoperatively. Postoperative sodium and sugar serum levels were evaluated for each patient. Data about tumor pathology and operative details were collected. The overall incidence of postoperative seizures was 47.2%, while it was 16.68% when examined at various time periods during a six-month postoperative course. Preoperative history of seizures, tumor pathology, cortical incision, prolonged brain retraction, parietal and frontal location of the tumor, postoperative hyponatremia and hypoglycemia were commonly associated with postoperative seizures. Avoiding such factors, when possible, might decrease the risk of postoperative epilepsy

Cognitive dysfunction in epileptic children in correlation to seizure type, frequency and egg changes

This work was conducted on 46 epileptic children with EEG recording to study the problem of intellectual impairment in epileptic children. The intellectual functions [verbal IQ [VIQ], performance IQ [PIQ] and general IQ [GIQ]] were assessed using Wechsler intelligence scale for children revised [WISC-R]. The results showed a statistical significant difference between patients and controls as regard intellectual functions with higher IQ scores of the control group. There was an insignificant difference between patients with different seizure type, however children with generalized tonic clonic seizures had lower IQ scores than those with absence or complex partial seizures. It was concluded that epileptic seizure itself had a detrimental effect on intellectual functions rather than other risk factors, thus intractable epilepsy strongly deteriorated intellectual functions. Partial versus generalized seizures and normal interictal EEG were good predictor of normal intellectual functions in epileptic children

Prognostic value of combined stapedial muscle reflex [Acoustic reflex], electro-neuronography and facial nerve latency test in patients with Bell's palsy

In this study, 20 patients with idiopathic facial nerve palsy were evaluated by electroneuronography [ENOG], facial nerve latency test [FNLT] and stapedial muscle reflex [acoustic reflex]. The study aimed to define the value of these tests as prognostic tools in Bell's palsy. The ENOG test results indicated that when the amplitude of the compound muscle action potential varied between 51% and 95% of the normal value, the neuronal damage was slight. When the muscle action potential decreased to a value below 51% of normal values, the prognosis for recovery was worse. FNLT results indicated that as the latency time extended, the recovery grade of the facial nerve worsened. The comparison with the index of facial nerve functional recovery showed that these two tests had a high percentage of correctness. Acoustic reflex measurement helped in determining the site of lesion and in the follow up of the patients. A combination of test battery was important, so that the determination of the lesion may be as correct as possible

Reproductive dysfunction in women with temporal lobe epilepsy

This work aimed to study the relation between progesterone and estrogen hormones and temporal lope epilepsy [TLE]. The serum levels of estradiol, progesterone, luteinizing hormone [LH], follicle stimulating hormone and prolactin were assayed for each of 40 consecutive women with TLE and 20 age matched healthy controls; 20 out of the 40 women had menstrual disturbances and 16 from them had reproductive endocrine disorders. Polycystic ovarian [PCO] syndrome and hypogonadotropic hypogonadism [HH] significantly occurred more often in women with TLE than in the general female population. Some patients had LH concentrations above the control range, but they had not any specific syndrome. While, the mean level of LH was significantly higher in patients than in the controls, its concentrations were above or below the normal control range in all women who had abnormal endocrinal findings. The mean level of progesterone was significantly lower in patients than in the controls and all these low levels were exclusively found in patients with polycystic ovarian syndrome [PCO] syndrome or hypogonadotropic hypogonadism [HH]