An analysis of breakthrough seizures and related factors in paediatric epilepsy patients.

OBJECTIVE: To determine the frequency of breakthrough seizures among paediatric patients suffering from epilepsy, and factors related to the precipitation of these seizures. METHODS: The cross-sectional study was conducted from July 1, 2018, to July 1, 2020, at the Combined Military Hospital Lahore and the Military Hospital, Rawalpindi, Pakistan, and comprised children of either gender aged 2-12 years diagnosed with any type of epilepsy presenting at the children outpatient department. Diagnosis of epilepsy was established by either a consultant adult neurophysician or a consultant paediatrician. The presence of breakthrough seizures was assessed by obtaining detailed history from the patient and the primary caregiver. Socio-demographic profile, duration of epilepsy and poly-pharmacy were noted. Data was analysed using SPSS 23. RESULTS: Of the 450 subjects, 259(57.6%) were boys and 191(42.4%) were girls. The overall mean age was 6.353±4.732 years. The presence of breakthrough seizures was noted in 227(50.4%) subjects. Children with young age, with low family income, and those in need of poly-pharmacy showed significantly higher odds for breakthrough seizures (p<0.05). CONCLUSIONS: The incidence of breakthrough seizures in epileptic children was high despite the anticonvulsant agents that were previously effective in controlling seizures.

Need for Swift Diagnosis of Primary Angiitis of Central Nervous System: A Case With Focal Motor Seizures of Hand Progressing to Aphasia.

Primary angiitis of the central nervous system (PACNS) is a rare disorder and difficult to diagnose. The time period from the presentation of the patient until a diagnosis can be protracted, which may result in further progression of the disease and poor patient outcomes. It has immensely varied symptomatology, further confounding swift diagnosis. We present a case of a 33-year-old male who had focal motor seizures with intact awareness of the right upper limb for three weeks prior to presenting to our hospital with acute right hemiparesis. One month into hospital admission, the patient developed complete motor aphasia while being investigated for the cause of multiple ischemic brain infarcts. The patient underwent immunosuppression along with plasmapheresis and pulse steroid therapy started prophylactically on suspicion of PACNS, which was subsequently confirmed by brain biopsy. Disease remission was achieved with rituximab.

Central Nervous System Vasculitis Secondary to Sarcoidosis: A Rare Case of Lupus Pernio With Complete Occlusion of Right Internal Carotid Artery.

Sarcoidosis is a systemic inflammatory disorder resulting from an inappropriate immune response to ubiquitous environmental stimuli. It has a predilection for African Americans and people of Northern European countries. The classic histology is that of a non-caseating granuloma. Central nervous system involvement is a rare occurrence in sarcoidosis and even in this manifestation, the presence of vasculitis is comparatively uncommon. We present a case of a 35-year-old female, who presented with complaints of persistent headache of moderate intensity and had a violaceous plaque on nose, being treated by a dermatologist. The patient on further workup had mildly raised proteins on cerebrospinal fluid analysis. MRI brain showed multiple foci in bilateral frontoparietal regions and centrum semiovale, while digital subtraction angiography brain depicted vasculitis of small vessels of brain and complete occlusion of right internal carotid artery at its origin. Biopsy of lesion on nose was performed that showed chronic granulomatous inflammation. A diagnosis of brain vasculitis secondary to sarcoidosis was made. The patient was treated with plasmapheresis and pulse steroid therapy initially, and later on with cyclophosphamide and azathioprine. This resulted in resolution of headache and nose lesion.

Transvenous Catheter-Based Thrombolysis With Continuous Tissue Plasminogen Activator Infusion for Refractory Thrombosis in a Patient With Behcet's Disease.

Behcet's disease (BD) classically presents with recurrent oral ulcers, genital ulceration, uveitis and skin manifestations. Middle-aged people are usually affected with the male gender being associated with severe variant of the disease. It can involve any organ system of the body. Although central nervous system and vascular involvement tend to occur less frequently, they are the commonest cause of mortality. We present a case of a 30-year-old man referred with suspicion of cerebral venous sinus thrombosis to our hospital and subsequently diagnosed with BD. The patient developed, despite being on immunosuppression and anticoagulation, extensive arteriovenous thrombi of lower limbs requiring catheter-directed thrombolysis with continuous 24-hour infusion of tissue plasminogen activator for refractory right lower limb venous thrombosis and placement of inferior vena cava filter to prevent pulmonary embolism. Later disease remission was achieved with rituximab.

Central Nervous System Tuberculosis With Shower Like Pattern of Intracranial Tuberculomas in an Immunocompetent Patient.

Central nervous system tuberculosis (CNS TB), though comparatively uncommon as compared to other forms of extrapulmonary tuberculosis (TB), results in high morbidity and mortality. The symptoms are non-specific and of a progressive nature resulting in delayed diagnosis. We present a case of CNS TB that presented two months after the onset of symptoms. The patient's condition reached the point of being bedbound. On investigation, the widespread involvement of the brain with shower-like pattern of ring enhancing tuberculomas and associated tuberculous meningitis was found. This was a surprising finding considering the patient was immunocompetent. Contrast-enhanced magnetic resonance imaging showed lesions in midbrain, pons, medulla, thalamus, bilateral cerebellar hemispheres and bilateral cerebral hemispheres. Upon treatment initiation the patient responded well with resolution of all lesions.

Xanthophyll: Health benefits and therapeutic insights.

Xanthophylls constitute a major part of carotenoids in nature. They are an oxidized version of carotenoid. Xanthophyll has widely drawn scientists' attentions in terms of its functionality, bioavailability and diversity. An assortment of xanthophyll varieties includes lutein, zeaxanthin, ß-cryptoxanthin, capsanthin, astaxanthin, and fucoxanthin. Chemically, lutein and zeaxanthin are dipolar carotenoids with hydroxyl groups at both ends of their molecules that bestow hydrophilic properties to them. Hydrophilic affinity in lutein and zeaxanthin makes better bioavailability in reaction with singlet oxygen in water phase, whereas non-polar carotenoids have shown to have less efficiency in scavenging free radicals. Xanthophylls have been studied for their effects in a wide variety of diseases including neurologic, ophthalmologic, oral, allergic and immune diseases. This review highlights pharmaco-pharmaceutical applications of xanthophylls as well asits drug interactions with beta-carotene. Different types of xanthophylls have been shown to have neuroprotective effects. Fucoxanthin demonstrated potent antiplasmodial activity. Lutein and zeaxanthin prevent the progression of age related macular degeneration. They have also demonstrated promising effects on uveitis, retinitis pigmentosa, scleritis, cataracts, glaucoma, retinal ischemia and choroideremia. Astaxanthin showed to have skin protecting effects against ultraviolet light injury. Astaxanthin have anti-allergic activity against the contact dermatitis especially to treat the patients having adverse reactions induced by steroids. Astaxanthin has been reported to exert beneficial effects in preventing oral lichen planus and early stage cancers. ß-cryptoxanthin has been considered a good candidate for prevention of bone loss via osteoblastic bone formation and inhibiting osteoclastic bone resorption. There is also some concern that higher dose of xanthophylls may be linked to increased risk of skin cancer and gastric adenocarcinoma. However this increased risk was not statistically significant when adjusted for confounding factors. Further researches including clinical studies are needed to better evaluate the efficacy and safety of xanthophylls in prevention and treatment of different diseases.