Equipotency of lacosamide to levetiracetam in new onset focal epilepsy: A randomized controlled trial.

Objectives: Levetiracetam (LEV) is a well-established broad spectrum antiseizure medication (ASM) effective in focal, generalized, and myoclonic seizures whereas lacosamide (LCM) is a comparatively newer ASM currently approved only as an add-on agent in focal seizures. The aim of the study was to assess the efficacy and the tolerability of oral LCM as monotherapy in adult people with epilepsy (PWE) with new onset focal onset epilepsy compared with those receiving LEV. Materials and Methods: In this open-label single-center non-inferiority trial, PWE aged between 16 and 65 years suffering from new onset focal seizures, with or without secondary generalization were put on LCM monotherapy or LEV monotherapy. Data regarding demographic characteristics, seizure type and etiology, LCM and LEV daily dose, seizure frequency at baseline and at 6 months of follow-up, and seizure freedom rates were recorded. Results: Thirty-five PWE on LCM (24 males), their mean age: 38.20 ± 16.62 years and 35 PWE on LEV (25 males, mean age: 38.91 ± 17.13 years) were enrolled. The most common type of seizure observed was focal to bilateral tonic-clonic seizure >70% followed by focal impaired awareness seizure and focal awareness seizure. Structural epilepsy was found in 21 among LCM group and 22 of LEV group. In the LCM group, the seizure frequency decreased from 3.33 ± 1.88 to 0.85 ± 1.09 (P = 0.001) at 6 months and from 3.61 ± 3.12 to 0.94 ± 1.24 (P = 0.001) in LEV group, intergroup difference (P = 0.74). At 6-month follow-up period, 78.9% in LCM arm and 87.9% in the LEV arm had experienced a 50% of reduction in seizure frequency while seizure freedom was attained in 43.3% of PWE in both the arms (P = 1). The most common treatment emergent adverse effects in the LCM group were fatiguability, dyspepsia, headache, and dizziness, while in the LEV group; somnolence and behavioral abnormality. Conclusion: Treatment with LCM met the non-inferiority criteria when compared with LEV. Therefore, it might be useful as first-line monotherapy for adults with newly diagnosed focal epilepsy.

Guillain-Barre syndrome as the initial presentation of systemic lupus erythematosus: Case report with a systematic and literature review.

Systemic lupus erythematosus (SLE) can affect multiple systems in which central nervous system (CNS) involvement is common, but peripheral nervous system involvement is also increasingly being recognized. Guillian-Barre syndrome (GBS) as the first manifestation of SLE has been reported, but rare and not well understood. A 39-year female presented with GBS-like illness but on evaluation found to have features of SLE. Cerebrospinal fluid (CSF) showed characteristic albuminocytological dissociation and nerve conduction study (NCS) was suggestive of demyelinating polyradiculoneuropathy. On evaluation, she was found to have polyarthralgia, autoimmune hemolytic anemia, class I Lupus nephritis, mild splenomegaly, and pleural effusion. Serum antinuclear antibody was 4+ positive (coarse speckled) and extractable nuclear antigen profile revealed anti-dsDNA and anti-Sm antibody positivity, with low complement level. She fulfilled the diagnostic criterion of SLE and was managed with both plasmapheresis and pulse steroids followed by cyclophosphamide monthly pulse and oral hydroxychloroquine maintenance and showed significant improvement. The literature review showed only 26 cases reported till now. GBS without any obvious trigger should be extensively evaluated, as the underlying etiology will affect the treatment protocol as well as the prognosis. Our report highlights the significance of early recognition of SLE as a trigger of GBS, which changes conventional GBS treatment.

Isolated intracranial hypertension without cerebral venous sinus thrombosis in APLA syndrome: an unique association.

BACKGROUND: Antiphospholipid antibody (APLA) syndrome is an autoimmune disorder predisposing to thrombotic complications affecting CNS either by arterial vaso occlusion or venous thrombosis. Cerebral venous sinus thrombosis (CVST) secondarily produces raised intracranial pressure (ICP). However intracranial hypertension without evidence of CVST is rare entity. CASE PRESENTATION: We present two cases of elevated ICP with absence of identifiable CVST. Case 1, a 28-year-old female presented with a 2 months history of headache followed by bilateral vision loss. Cerebrospinal fluid (CSF) opening pressure and fundoscopy along with Contrast Magnetic resonance imaging (MRI) was suggestive of Idiopathic intracranial hypertension (IIH) and patient improved with acetazolamide. 5 months later she presented with acute onset right sided hemiparesis. MRI showed acute left Middle cerebral artery (MCA) territory infarct with normal contrast Magnetic resonance venography (MRV). Anti-cardiolipin and Beta 2 glycoprotein (both IgG and IgM) titres were elevated. Case 2, a 23-year-old female presented with headache and diplopia of 2 months duration. Based on CSF, fundoscopy and contrast MRI brain was diagnosed as IIH and she too responded to diuretics. 2 years later she presented with recurrence of headache and APLA profile showed elevated beta 2 glycoprotein IgG and IgA. CONCLUSION: This is an important non thrombotic complication of APLA syndrome and requires further large-scale study for insight into the pathogenesis and early recognition to avoid future complications.