Adult tonic-clonic convulsive status epilepticus over the last 11 years in a resource-poor country: a tertiary referral centre study from southern Thailand.

Status epilepticus is a common condition in patients admitted to hospital in resource-poor countries and reports indicate that aetiology, factors of poor outcome, and treatment strategies are variable. To date, there is no report of a prospective study in Thai adults. Herein, we investigated the aetiology, clinical features, factors of predicted poor outcome, and treatment strategies in Thai adult patients who presented with convulsive status epilepticus. A total of 180 patients, whose ages ranged from 15 to 106 years, were included. Of these, 121 patients (67.2%) had acute symptomatic aetiology. The most common aetiology of status epilepticus was encephalitis (36.1%), followed by scarring of the cerebral hemisphere (15%). The median duration of status epilepticus before treatment was three hours. The rate of mortality in the study was 26.7%. Poor outcome was identified in 112 (62.2%) patients. For referral patients, all received only intravenous drugs before referral. The variables that correlated with poor outcome were aetiology and duration of status epilepticus. An approach to incorporate improved prevention of encephalitis, a more effective transportation system, and provision of the essential intravenous antiepileptic drugs would effectively increase the response to treatment.

The association between BsmI polymorphism and bone mineral density in young patients with epilepsy who are taking phenytoin.

PURPOSE: This study sought to determine the association between BsmI polymorphism and bone mineral density, 25-hydroxyvitamin D, and parathyroid hormone levels in patients with epilepsy. METHODS: We recruited ambulatory young adults with epilepsy who were taking phenytoin. Data regarding demographics, basic laboratory studies, history of clinical epilepsy, parathyroid hormone, and vitamin D levels, as well as BsmI polymorphism of the vitamin D receptor (VDR) gene, were obtained. The bone mineral density (BMD) of the lumbar spine and left femur were measured using dual-energy x-ray absorptiometry. KEY FINDINGS: Ninety-four patients were included in the study. BsmI polymorphism had a statistically significant lower T-score of the lumbar spine and left femoral neck than patients with wild-type VDR gene (p < 0.01 and p < 0.01, respectively). In addition, patients with BsmI polymorphism had a statistically significant lower z-score of the lumbar spine and left femoral neck than patients with wild-type VDR gene (p < 0.01 and p < 0.01, respectively). The 25-hydroxyvitamin D level in patients with wild-type genes was higher than in epileptic patients with BsmI polymorphism (p < 0.01 and p < 0.01, respectively). Parathyroid hormone level in patients with wild-type VDR gene or patients having BsmI polymorphism was not correlated with BMD at either site. SIGNIFICANCE: In patients with epilepsy taking phenytoin, having BsmI polymorphism was associated with lower BMD.

Role of CYP2C9 polymorphism in phenytoin-related metabolic abnormalities and subclinical atherosclerosis in young adult epileptic patients.

PURPOSE: We investigated the influence of the CYP2C9 polymorphism on the lipid profile, insulin resistance, and subclinical atherosclerosis in young epileptic patients. METHODS: We performed a cross-sectional study to evaluate the association between CYP2C9 polymorphism and lipid profile, glucose homeostasis, and subclinical atherosclerosis in young epileptic patients via the ankle brachial index. RESULTS: The frequencies of CYP2C9*1 (CYP2C9 wild type gene) and CYP2C9*3 (CYP2C9 polymorphism gene) were 75% and 25%, respectively. The mean serum total triglyceride and LDL levels were significantly higher in the wild type gene subjects than in the CYP 2C9 polymorphism gene subjects. Also, the CYP 2C9 polymorphism had marginally significant lower mean serum HDL levels than the wild type gene subjects. No patients with CYP 2C9 polymorphism gene had elevated fasting blood sugar, and insulin resistance was found in only 10 of the 75 subjects. The mean ABI was statistically significantly lower in the wild type subjects than in the CYP2C9 polymorphism gene subjects. CONCLUSION: Our study indicates that young epileptic patients with the CYP2C9 polymorphism gene have a low risk of subclinical atherosclerosis.

A survey study of etiology of altered consciousness in the emergency department.

BACKGROUND: Altered consciousness (AC) is a common presenting problem in the Emergency Department (ED), the causes of which can be either intracranial or extracranial in origin. OBJECTIVE: To determine the common etiologies of AC among patients in the ED of a medical teaching hospital and to build up a proper differential diagnosis. MATERIAL AND METHOD: A retrospective review of the medical records of patients who presented with AC in the ED between January and August 2004 was conducted Patient characteristics and demographic data as well as the etiologies of AC were presented in descriptive pattern. RESULTS: There were 350 patients, of whom 67 (19.1%) were admitted, 38(10.9%) were transferred to other hospitals due to full occupancy, 35 (10%) died in the ED, and the rest (60%) were discharged and re-evaluated The mean age was 60.3 years old with 57.1% males and 42.9% females. The etiologies included neurological disorders (29.1%), endocrine/metabolic derangement (20.8%), infectious diseases and sepsis (18.8%), cardiovascular disorders (10%), psychiatric illness (8.8%), pulmonary (7.1%), and toxicological causes (5.1%). CONCLUSION: Though neurological disorders or intracranial causes were the most common etiology of AC in the ED, they accounted for only one-third of all cases in the ED. The larger proportion of AC cases was extracranial abnormalities including adverse effects from current medications.

Quality of life in epileptic patients in southern Thailand.

OBJECTIVE: To determine the risk factors for a low quality of life in Thai epileptic patients. MATERIAL AND METHOD: A cross-sectional study was conducted at Songklanagarind Hospital, Thailand. Epileptic patients aged 15-50 years old, who had been treated with a stable dose of antiepileptic drug(s) for more than three months, were enrolled Those who had other chronic medical illnesses and pregnant women were excluded. All subjects completed a self-report questionnaire that included questions about the quality of life in epilepsy-31 (QOLIE-31), hospital anxiety, depression score (HADS), age, sex, occupation, marital status, education level, medical insurance, seizure frequency, trauma due to seizure activity, duration of epilepsy, and medication analysis. RESULTS: In the univariate analysis, significant (p < 0.05) factors affecting the quality of life included seizure frequency, history of trauma due to seizures, depression, and anxiety. In the multivariate regression analysis, seizure frequency, anxiety, and depression were significant. Anxiety and depression were significant statistical factors in explaining a lower quality of life. Throughout the results, seizure frequency, depression, and anxiety had an inverse relation to scores. Age, sex, education, medical insurance, occupation, marital status, and medication were not significant for quality of life. In the subscale analysis of quality of life, seizure frequency was associated with seizure worry; occupation with energy/fatigue; anxiety with all subscale QOLIE; depression with emotional well-being, overall, energy/fatigue and cognitive and social functions; marital status with energy/fatigue; and medical insurance with medical effects. CONCLUSION: These findings indicated that mood disorder and seizure frequency could be a powerful predictor for the quality of life.

The validation of the disease-specific questionnaire for health-related quality of life in Thai patients with hemifacial spasm.

OBJECTIVE: To investigate the reliability and validity of the Thai version of disease-specific health-related quality of life instrument for patients with hemifacial spasm (HFS) as well as their response to botulinum toxin treatment. MATERIAL AND METHOD: A Thai version of HFS-30 has been developed with the permission of the author. Thirty patients with HFS were asked to complete this Thai HFS-30, the 6-point disability scale before treatment and between four and six weeks after botulinum toxin injections. Peak improvement (0-100%) was subjectively assessed by each patient between four and six weeks after injection. They were also asked to answer the existing Thai SF-36 questionnaire before treatment to test its correlation with Thai HFS-30. Another group of ten patients completed the questionnaire and then a second identical copy after a 2-week interval. The reliability, validity, and responsiveness were subsequently analyzed. RESULTS: The Thai HFS-30 showed a Cronbach's alpha coefficient of 0.78 and no significant difference of a test-retest reliability. The total content validity was 0.88 (range 0.5-1.0). There were good correlations between both the Physical and Mental Health parts of the Thai HFS-30 and Thai SF-36 (p < 0.05 and p < 0.01, respectively). The Thai HFS-30 also demonstrated a response to treatment similar to the 6-point disability scale and the peak improvement. CONCLUSION: The Thai version of HFS-30 is a valid, reliable, and sensitive to change instrument for disease specific health-related quality of life assessment.

Anxiety and depression in Thai epileptic patients.

OBJECTIVE: To study the prevalence of depression and anxiety in Thai epileptic patients at Songklanagarind Hospital, a tertiary care center in the South of Thailand. MATERIAL AND METHOD: One hundred and twenty six patients were included in the present study. A HADS questionnaire and demographics data were used for data collection in the present cross-sectional study. RESULTS: Thirty-nine percent of the respondents had anxiety and 20% had depression. Predictors of anxiety by univariate analysis were being female (p = 0.033) and seizure frequency (p = 0.001). Predictors of depression were seizure frequency (p = 0.001) and a history of trauma associated with seizure activity (p = 0.005). Age, type of seizure, amount of medication, duration of disease, socioeconomic status, occupation, education level, and marital status were not predictors of depression or anxiety. CONCLUSION: There is a high prevalence of depression and anxiety in Thai epileptics. Risk factors for depression are seizure frequency and history of trauma while for anxiety they are gender and frequency of seizure.