Association analysis between intractable seizures and cortical brain lesions [clinical, EEC and MRI studies]

The early prediction of pharmacoresistant partial epilepsy is a major challenge in management of epilepsy. The main predictors are the presence of brain lesions demonstrated by neuroimaging or suggested by a neurological deficit or a developmental delay or electroclinical evidence. Little is known about the relationship between the location of the epileptogenic area and refractory epilepsy. The purpose of this study was to establish the contribution of clinical features, EEC recordings and MRI findings as a trial to clarify the relationship between intractable seizures and cortical brain lesions. 26 patients [12 males and 14 females] were evaluated in this study. All patients and their parents fulfilled certain questionnaires about the different types of the used antiepileptics and the duration of each group, family history, history of head trauma, fever, systemic illness and paralytic manifestations were recorded. Characteristics of seizures, loss of consciousness and tonic clonic movements. Clinical examination, EEG recording and MRI were performed to all patients. All patients had a certain degree of resistance to drug treatments. Ages at seizure onset varied from 3 months to 4 years. The mean age at the first seizure in patients with apositive family history of epilepsy was 26 months compared with 3.8 years in those patients with no relatives having epilepsy. Statistical evaluation showed that patients with an onset of generalized seizures earlier than 3 years of age were found to be more impaired intellectually. We could classify our examined patients after clinical examination, EEG recording and MRI findings into the following; 42.3% showed frontal lesions, 19.2% showed parietal lesions and 38.4% showed temporal lesions. The diagnosis of cortical lesions was based on MRI findings which varied from one patient to another as cortical thickening, abnormal gyration, focal heterotopia focal atrophy and hyperintense signal on T2-weighted images. The results were discussed from the fact that, when clinical and electroencephalographic data are not satisfactory to localize the epileptogenic areas in patients with intractable seizures, neuroimaging techniques in children and adult are essential MRI can be considered as a crucial component in the evaluation of refractory epilepsy, it can change management of this type of epilepsy from medical treatment to surgical strategy

possible role of serum prolactin analysis in diagnosis of multiple sclerosis

Prolactin [PRL] belongs to the growth and lactogenic hormone family and has potent immunomodulating properties. Mild hyperprolactinemia has been found to enhance several autoimmune diseases and increased PRL plasma levels have been described in multiple sclerosis [MS]. As studies of PRL serum levels in MS patients have led to conflicting results we tried in this study to clarify the question of prolactin alterations in MS. We correlated serum PRL baseline value in 15 MS patients with disease course, activity and clinical severity compared with 20 sex and age- matched healthy controls. We excluded conditions leading to rise in PRL; such as pregnancy and lactation. Serum PRL levels were measured in fasting blood samples. We recorded the duration, subtypes, clinical manifestation and the expanded disability status score [EDSS] for each case of the MS patients. There was a statistically significant difference between patients and control groups. There was a high percentage of subjects with elevated PRL levels among the patient group[20%] [p=0.036*]. There was no statistical significant relationship between the patients with elevated serum PRL levels and the duration, activity and EDSS of the disease. The results were discussed from the fact that PRL does not seem to be relevant as an activity marker in whole MS patients. It is not clear whether PRL is primarily involved in the pathogenesis of MS or just exists as a secondary phenomenon depending on the localization of MS plaques

Vestibular evoked myogenic potentials in multiple sclerosis

Vestibular evoked myogenic potential [VEMP] is an otolith-mediated, short-latency reflex recorded from the sternocleidomostoid muscle in response to intense auditory clicks used for evaluation of the vestibulo-spinal pathway. This study aimed at shedding light on the sensitivity of VEMPs in detection of occult vestibular pathway lesions in patients suffering from multiple sclerosis [MS]. VEMPs were recorded from 25 MS patients. Clinical data were evaluated for possible brain stem affection, their EDSS scores were recorded. All patients underwent visual evoked potential [VEP], brainstem auditory evoked potential [BAEP], somatosensory evoked potential [SSEP] studies and magnetic resonance imaging [MRI]. VEMPs were also recorded in 25 age and sex matched controls as well. VEMPs showed abnormal P13 and N23 waves in 56% of Patients, VEP in 56%, BAEPs in 44%, SSEPs in 28% and MRI in 80%. MRI showed better sensitivity in detecting brain stem plaques yet patients with normal MRI had abnormal VEMPs and BAEPs and VEMPs had nearly equal sensitivity in detecting brainstem plaques in symptomatizing group; however VEMPs were more sensitive than BAEPs in non symptomatizing group. Also we found no significant correlation between VEMPs and MRI or BAEPs. VEMPs is a simple, non-invasive, safe and quick method, which should be considered as a complementary neurophysiological tool for evaluation of possible brainstem dysfunction