International Journal of Epilepsy

Background and purpose Studies in the animal models of epilepsy have suggested the anti-seizure effects of neuroactive steroids and its derivatives in kainic acid and pilocarpine induced limbic seizures and status epilepticus in mice, but no such studies have been reported in the published literature on the role of allopregnanolone in chemical kindling model and its interaction with sodium valproate. The purpose of this study was to evaluate the interaction between sodium valproate and allopregnanolone in pentylenetetrazole induced kindling model in rats.

Methods In a PTZ kindled Wistar rat model, sodium valproate and allopregnanolone were administered 30 min before the PTZ injection. The PTZ injection was given on alternate day till the animal became fully kindled or till 10 weeks. The parameters measured were latency to develop kindling and incidence of kindling, histopathological study of hippocampus, hippocampal anti-oxidant parameters and hippocampal DNA fragmentation studies.

Results In this study, the combination of low dose of allopregnanolone with low dose of sodium valproate showed a similar beneficial effect to that of a higher dose of sodium valproate in significantly reducing the number of kindled animals (0/8) as compare to PTZ control group (5/8) as well as the seizure scores and the histopathological scores. The combination significantly reduces oxidative stress by significantly decreasing the MDA levels, and increasing the SOD levels and GSH levels in the hippocampus of rats as compared to PTZ control group. So all these data suggest the antiepileptic effect of the combination and confers the synergistic interaction between the allopregnanolone and sodium valproate.

Conclusions It can be concluded that by choosing this combination the dose of sodium valproate can be reduced and thereby reduces the incidence of adverse effects caused by sodium valproate and hence proves to be a useful combination clinically. This study has lead the basis to further investigate the various combinations of neurosteroids and valproate in the process of epileptogenesis with better side effect profile.

Đặc điểm kháng thuốc dẫn đến những khuyết tật nghiêm trọng, không thể phục hồi và tử vong sớm trong khoảng 30% trường hợp động kinh mặc dù đã được điều trị đầy đủ và hợp lý bằng các loại thuốc chống co giật (ASDs) có sẵn mà không có nguyên nhân tiềm ẩn. Dựa trên một khối lượng lớn chứng cứ cho thấy tác dụng chống co giật của taurine ở động vật thí nghiệm và biên độ an toàn rộng rãi ở người, việc bổ sung acid amin ức chế này vào các ASDs có sẵn dường như mang lại triển vọng điều trị động kinh kháng thuốc.

Phương pháp Chúng tôi đã khảo sát tác động chống co giật của lamotrigine (15 mg/kg), levetiracetam (40 mg/kg), carbamazepine (40 mg/kg), phenytoin (35 mg/kg) và taurine (50, 100 & 200 mg/kg) ở chuột gây động kinh bằng pentylenetetrazole đã được tiền điều trị bằng lamotrigine (LPK), đây là mô hình mô phỏng các đặc điểm chính của động kinh kháng thuốc, cả về ASDs đơn lẻ hay kết hợp, trong đó ba liều lượng khác nhau của taurine được bổ sung cùng các ASDs đã thử nghiệm.

Kết quả Cả ASDs và taurine đều không có khả năng ức chế cơn co giật toàn thể ở chuột LPK. Tuy nhiên, việc bổ sung taurine đã rõ ràng phục hồi tác dụng chống co giật của các ASDs đã thử nghiệm. Các nghiên cứu sinh hóa thần kinh tiếp theo đã chỉ ra rằng mức taurine cao hơn trong hồi hải mã và vỏ não đã phục hồi sự mất cân bằng giữa các chất dẫn truyền thần kinh kích thích chính, glutamate và GABA, chất dẫn truyền ức chế tương ứng của nó.

Kết luận Những phát hiện này nhấn mạnh rằng việc bổ sung taurine vào các ASDs có thể hữu ích trong việc điều trị động kinh kháng thuốc. Do đó, việc xác thực lâm sàng thêm là được khuyến khích.

Introduction Marriage is a socially challenging barrier in the personal lives of people with epilepsy worldwide. However, it is during arranges marriages, which are common in South Asian communities, that epilepsy is most profoundly stigmatizing. We hypothesized that the felt stigma associated with epilepsy during arranged marriages affects women more frequently and intensely.

Materials and methods A pilot study in married (n = 38) and unmarried PWE (n = 58) and general public (n = 150) to explore gender-based differences in the stigma associated with epilepsy during arranged marriages.

Results Majority unmarried PWE (87%) considered arranged marriage as the best way to realize their matrimonial plans. More unmarried women (72%) apprehended problems in adhering to their epilepsy medications regime after marriage (p 0.009) and 50% apprehended victimization in marriage on account of epilepsy (p 0.001). Moreover, 41% of the married women with epilepsy felt that the disclosure had a negative impact on their married life (p 0.047).

Conclusions South Asian WWE experienced more felt stigma than men before and after arranged marriages and this might impact a number of health related psychosocial outcomes. The lack of past experience with epilepsy was associated with a number of misplaced beliefs about and attitudes towards epilepsy.

Background Epilepsy is one of the most prevalent neurological disorders. Around 50 million people worldwide suffer from Epilepsy, 85% of them are from the developing countries. It is a most significant as well as common brain disorder worldwide. Sodium channel alpha 1 subunit gene (SCN1A) is most commonly mutated the gene in different forms of epilepsy.

Objective To screen the genomic damage and SCN1A gene mutation in patients with epilepsy.

Methods To screen the genetic instability of SCN1A gene using Buccal micronucleus cytome (BMCyt) assay and molecular analysis with Single Strand Conformation Polymorphism (SSCP) technique was used to observe the variations in SCN1A gene.

Results We found significant differences in buccal cells of patients than controls. So, we can interpret that BMCyt assay would be a minimally invasive biomarker to detect DNA damage and mutation screening in the SCN1A gene with SSCP technique showed no variation in epileptic patients.

Conclusion These data confirmed that there is certainly DNA damage and no mutations in the SCN1A gene; hence the genetic instability has occurred in epileptic patients.

Objectives To investigate the relationship between time to antiepileptic drug (AED) treatment (TTT) and seizure outcome in a high treatment gap sub-Sahara African setting.

Methods Clinical and demographic characteristics of 72 adults with epilepsy aged 18–75 years were obtained. We estimated TTT as the difference between the duration of epilepsy and the duration of treatment. Indices of clinical outcome including seizure severity and 6-month disease remission were documented. The effects of TTT and other clinical and demographic characteristics on clinical outcomes were tested using bivariate and logistic regression analyses.

Results Forty (55.6%) of the participants initiated treatment within 5 years of seizure onset (TTT ≤ 5 years) while 32 (44.4%) initiated treatment after 5 years (TTT > 5 years). There was moderate to strong correlation between TTT and age of onset (p = .009), age at treatment initiation (p = .026), duration of epilepsy (p = .000), and seizure severity (p = .020). The TTT > 5 years group had an earlier mean age of onset (p = .015) and higher seizure severity score (p = .001) and were less likely to be in 6-month disease remission (p = .014). Time to treatment ≤5 years was the only independent predictor of lesser seizure severity (OR = 0.163, 95% CI = 0.041–0.649) and better 6-month remission (OR = 0.154, 95% CI = 0.031–0.770) after adjusting for age of onset, duration of epilepsy, and number of AEDs.

Conclusion Delayed treatment initiation is common in our sample and independently associated with poor seizure outcome.

Hemi convulsion-Hemiplegia-Epilepsy (HH/HHE) syndrome is a very rare catastrophic epileptic syndrome in childhood which follows a prolonged focal motor status epilepticus in infancy and early childhood. Here we are describing the clinical, MRI and electrographic characteristics along with long term outcome of three children with HH/HHE syndrome. A review of the current literature on HH/HHE syndrome is attempted stressing on the diagnostic features and the neurobiological relationship between prolonged focal motor status epilepticus and subsequent development of HH/HHE syndrome. Early identification of this syndrome may help the treating physician in providing families with a relatively accurate prognosis regarding the functional outcome and subsequent development of epilepsy.

Background and purpose Our goal was to determine fiber tract integrity in hippocampal sclerosis (HS) using diffusion tensor imaging (DTI) and to correlate white matter damage with other pathology in this disease.

Methods Twenty-six patients and eight controls were studied with DTI tractography for 8 pairs of white matter fiber tracts and 2 commissural tracts. Fractional anisotropy (FA) of the fiber tracts was compared with controls. The FA of select fiber tracts was also compared with change in T2 signal in the anterior temporal lobe (ATC), and the performance on neuropsychological tests.

Results In comparison with controls, subjects with left sided hippocampal sclerosis (L-HS) had 3 ipsilateral fiber tracts with decreased FA. The FA of fiber tracts was similar in right sided HS (R-HS) to controls. The ipsilateral inferior longitudinal fasciculus had a decrease in FA that correlated with the ATC (T2 signal change). The right superior longitudinal fasciculus had a decrease in FA proportional to lower performance on tests of memory and language.

Conclusion The subjects with L-HS had more extensive structural abnormalities involving white matter tracts, both ipsilateral and contralateral. In contrast, subjects with R-HS had limited changes in white matter integrity. Pathology of white matter appears to be involved in deficits associated with HS, including ATC and cognitive performance.

Background Tetranectin concentration has been identified as a biomarker of several types of metastatic and malignant cancers. The role of tetranectin has also be seen in some neurological disorders. We aimed to estimate the plasma tetranectin concentration in different groups of people with epilepsy (PWE) followed-up for a year. As a secondary objective, the clinical and social characteristics were also correlated with the tetranectin levels.

Methods We enrolled 90 subjects grouped as Newly-diagnosed epilepsy (NDE), Drug-effective epilepsy (DEE), and Drug-refractory epilepsy (DRE) and an age-gender matched control group (n = 30). The plasma samples were collected thrice at the six-month interval and were analysed for the tetranectin concentration using S-ELISA.

Results The mean plasma tetranectin levels at the baseline test were significantly lower for the DEE (6.294 ± 0.806) and DRE (7.572 ± 0.545) groups compared with control group (9.71 ± 0.628) but not the NDE group (8.651 ± 0.859 vs. 9.71 ± 0.628; p > 0.05). On a year of follow-up, the tetranectin levels for the NDE group significantly decreased (p < 0.001) matching with that of the DEE and DRE group. Multivariate linear regression analysis showed that gender (p = 0.035) in the DRE group and seizure type (p = 0.040) and diet (p = 0.046) for the NDE group were significantly correlated.

Conclusion The plasma tetranectin level in PWE significantly decreased as the disease progressed irrespective of the stage of epilepsy. Thus, tetranectin could be considered as a potential progressive biomarker for epilepsy. The study outcome suggests further investigation for the possible link of tetranectin levels with clinical and social parameters.

Background Status epilepticus (SE) is a common neurologic emergency. Immediate treatment to stop seizure activity and prompt diagnostic evaluation to recognize potentially treatable causes are paramount in the management of SE. Thus, increased awareness of presentation, etiologies, and treatment of status epilepticus SE is central in the practice of critical care medicine. However, there is a paucity of information on SE from Nigeria.

Objective We evaluated the clinical profile and predictors of one-month outcome in a group of Nigerian patients with SE.

Methodology Patients with SE were recruited from the medical, high dependency unit, intensive care unit and accident and emergency departments of a tertiary hospital from 2008 to 2013. The outcome was assessed using Glasgow Outcome Score (GOS). The outcome, which was categorized into dead (GOS = 1) or alive was analyzed in a multivariate logistic regression model.

Result A total of 76 patients was studied. The four most common underlying etiologies were stroke, antiepileptic drug (AED) non-compliance, CNS infections and metabolic derangement. Fifty-nine (77.6%) patients survived. Duration of seizure, delay in initiation of treatment (Odd ratio (OR) = 4.4, 95% CI = 1.17–16.56), refractory status epilepticus (OR = 87.1, 95% CI = 12.94–781.1) were significantly associated with death. On multivariate analysis, however, refractory status epilepticus remained an independent predictor of death.

Conclusion Our study showed that the most common underlying etiologies in SE were stroke, antiepileptic drug non-compliance CNS infections and metabolic derangement. Duration of seizure, delay in treatment and refractory the SE were significantly associated with death, but refractory seizure was an independent predictor of death in SE.