Platform Abstracts

Sodium Channel Blockers in the 21st Century

Martin Brodie

West Glasgow ACH-Yorkhill, Glasgow, United Kingdom

Purpose: Sodium channel blockers have been the mainstay of the pharmacological management of focal and generalized tonic clonic seizures for more than 50 years. Focus will be made on phenytoin, carbamazepine, oxcarbazepine, rufinamide, lacosamide, eslicarbazepine acetate and lamotrigine.

Method: Their efficacy and tolerability will be discussed, as will problems associated with their use.

Results: All these AEDs share a similar side effect profile, although some are more likely to cause idiosyncratic reactions than others.  Some are enzyme inducers and most are minor teratogens. There is increasing evidence that they differ mechanistically, with the newer agents, lacosamide and eslicarbazepine acetate, having their major pharmacological effect on the slow inactivated state of the sodium channel.

Conclusion: There seems little doubt that sodium channel blockers will have an enduring place in the management of epilepsy well into the 21st century.

 

Assessment of adverse effects of antiepileptic drugs in controlled and uncontrolled epileptic patients

Lobna El Ghoneimy, Hassan Hosny, Sandra Nasr

Neurology Department, Cairo University, Cairo, Egypt

Purpose: Determine the side effects profile of AEDs and attempt to relate the side effects to the prescribed doses and different clinical characteristics of epileptic patients.

Method: Three hundred epileptic were randomly selected from the epilepsy outpatient clinic.  The patients were then divided according to the type of epilepsy into focal, generalized or other syndromes.  The patients were then subdivided into controlled or uncontrolled and on mono- or poly-therapy.  All of the patients were subjected to the 19 items adverse effects profile (AEP) instrument for complete screening of any possible known side effects of the AEDs.

Results: The AEP scoring system results, ranged from 19 to 62, with a mean of 33 ± 0.894.  The most common AEs were memory problems (42%), headache (34.7%), nervousness (33.3%), dizziness (28%), shaky hands (25.3%), and disturbed sleep (24%).There was a statistically significant increased proportion of tiredness, restlessness, nervousness, hair loss, blurred vision, shaky hands and weight gain in patients on VPA (P=0.019, P=0.013, P=0.005, P=0.058, P=0.058, P=0.000, P=0.004, respectively) when comparing VPA to the other two drugs.  There was a statistically increased GIT upset and sleepiness, in Phenytoin users (P=0.001, and P=0.018 respectively) when compared to the other two drugs.

Conclusion: Adverse effects prevailed in certain drugs regardless of the dose. Which means that not always increasing the dose of the drug would result in an increase in the adverse effect profile. However, the use of screening measures, such as questionnaires or checklists, can result in overestimation.

 

Awake Craniotomy and Brain Mapping, Technical Nuances and Outcome

Ahmed Morsy

Department of Neurosurgery, Zagazig University, Zagazig, Egypt

Purpose: The goal of surgery in the treatment of intrinsic cerebral lesions related to eloquent areas is to maximize the resection and to spare the functions. But frequently surgery for such lesions under general anesthesia results in poor extent of resection or permanent postoperative deficits, or both.

We review our initial experience in awake craniotomy and intraoperative brain mapping for resection of eloquent areas lesions in oncology and epilepsy cases.

Method: We performed a 2-year prospective review of patients who underwent awake craniotomy under local anesthesia and monitored conscious sedation at the National Neuroscience Institute, Singapore and Zagazig University Hospitals, Egypt. All patients had lesions in close proximity to eloquent area. Pre- operative comprehensive neuropsychological evaluation, contrast-enhanced MRI, functional MRI, and DTI were performed. Brain mapping was done by direct cortical and subcortical stimulation. Intraoperative physiological monitoring was carried out by assessment of speech, motor and sensory functions during the process of surgical resection. All resections were evaluated and verified by postoperative imaging. Postoperative complications and neurological deficits, as well as extent of resection, were evaluated.

Results: A total of 40 patients underwent awake craniotomy and intraoperative brain mapping. There were 23 male patients and 17 female patients, with a mean age of 42.8 years. There were no major anesthetic complications and no perioperative deaths. 4 patients (10%) had intra-operative seizures. Postoperative neurological deficits were seen in 6 patients (15%) and this was permanent in only 1 patient (2.5%). The degree of resection achieved was greater than 90% in 80% of patients and a further 20% had greater than 80% resection.

Conclusion: Awake craniotomy and brain mapping is a safe technique that allows maximal resection of lesions in close relationship to eloquent areas and has a low risk of neurological deficit.

 

QuoStatus: a software package for the analysis of the progression of Status Epilepticus in EEG signals

Peter Roper, Erika Scholl, Jay Spampanato, Edward Dudek

University of Utah, Salt Lake City, USA

Purpose: We present QuoStatus, a free, user friendly, open-source, analysis software program for the post-hoc analysis of the progression of status epilepticus in single channel EEG signals and assessing the efficacy of anti-convulsants.

Method: QuoStatus computes three quantities for each EEG trace submitted for analysis: (1) the change in power in a given frequency band; (2) the change in coastline length of the EEG; and (3) the change in spike frequency of the EEG.

Results: The program analyzes how status epilepticus progresses by measuring these quantities every fifteen minutes for up to 48 hours post-insult, and can compare up to six experimental cohorts. It then computes the relevant statistics for each cohort as well as determining statistical significance between the means of all cohorts.

Conclusion: QuoStatus produces camera ready graphs as output as well as saving the raw data in excel format. It can analyze Biopaq Acknowledge (.acq) files, Cambridge Electronic Design spike2 (.smr) files and European Data Format (.edf) files, and other file formats can be included on request. It has a simple installation program, which can be downloaded from our website, will run on all major operating systems, is written in Python 2.7 and QT and is released as freeware under the GNU GPL 3.0 software license. Its source code and underlying algorithms are available.

 

Poster Abstracts

Cognitive Dysfunction in children with benign childhood epilepsy with centrotemporal spikes:  An Event Related EEG Desynchronization and Synchronization Study

Mostafa Elkholy1, Hanan Hosny1, Mona Nada2, Neveen Elfayoumy2, Asmaa Ebraheim2

1Faculty of Medicine, Beni Suef University, Giza, Egypt, 2Faculty of Medicine, Cairo University, Cairo, Egypt

Purpose: quantitative analysis of the brain responses to cognitive tasks using event related desynchronization (ERD) event related synchronization (ERS), and to find out if a disruption in these measures correlates with cognitive dysfunction in these children or not

Method: The study included 50 children (30 patients and 20 matched healthy controls). The methods included for both groups clinical assessment, EEG recording, neuropsychological and behavioral measures, P300 averaging and quantitative EEG analysis to measure alpha power ERD and ERS in six different brain regions during an auditory oddball paradigm, in addition to brain imaging of the patient group

Results: Epileptic children showed poorer cognitive performance in neuropsychological and behavioral tests (verbal IQ, performance IQ, letter cancellation test and the number of correct responses). In addition, both groups showed diffuse alpha power attenuation in response to target tones, however this alpha power ERD was significantly smaller in the epileptic children compared to the healthy group.

No significant P300 wave changes between groups and no significant correlation between the alpha ERD percentage and neuropsychological results were found.

Conclusion: children with BCECTS have subtle cognitive dysfunction, especially in the domains of language, attention, memory and executive functions. The smaller alpha ERD in epileptic children could be an electrophysiological correlate of disruptive brain activation related to the cognitive dysfunction in these children. However, alpha power ERD/ERS technique could be complementary rather than supplementary to neuropsychological testing in cognitive assessment of these children

 

Latency to the first epileptiform activity in the EEG of epileptic patients

Reda Badry

Assiut University Hospital, Department of Neurology and Psychiatry, Assiut, Egypt

Purpose: To determine the latency of the epileptic activity on EEG in epileptic patients.

Method: Two hundred patients with epilepsy of different age groups were recruited in this study. We excluded those who had a definite seizure within the last 24 h and those with acute symptomatic seizures. Continuous EEG (for 2 h up to 24 h) was analyzed to find out the latency of the first clear epileptic activity

Results: Epileptiform activity was detected in 45.45% of the patients in the first 20 min of EEG recording. This percentage increases to 55% after 1 h and 64% after 2 h of recording EEG trace. After 24 h, 85.45% had epileptiform activity.

Conclusion: Diagnostic yield of digital EEG increases steeply with increasing the duration of the trace and hence the time of routine EEG should be increased to 1–2 h. A 24 h EEG is of utmost value in diagnosis of epilepsy if the routine EEG is not helpful in this task.

 

Electroencephalography in juvenile myoclonic epilepsy

Fatma Laatar, Amina Gargouri Berrechid, Istabrak Abdelkefi, Imen Kacem, Amina Nasri, Mouna Ben Djebara, Riadh Gouider

Neurology department, UR 12 SP21, Razi Hospital, Tunis, Tunisia

Purpose: To describe the EEG abnormalities found in Juvenile myoclonic epilepsy (JME) patients.

Method: Data from patients with JME examined in the neurology department of Razi Hospital between 2003 and 2015 were analysed retrospectively. All patients had well-documented diagnoses of JME. EEG examinations were performed using 10/20 system with 21 electrodes. We obtained conventional EEG recordings from all patients along with activating methods.

Results: We included 100 patients (58 women, 52 men), all patients had normal background activity. The EEG was normal in 39 patients (35.45%), generalised interictal abnormalities were found in 27.27% of cases, generalised abnormalities with focal maximum were seen in 28.18%, focal discharges were seen in 9.09%. Amplification with hyperventilation and photosensitivity were found in 30% and 20.9% respectively.

Conclusion: We conclude that focal interictal discharges in JME are common. Those findings must be known to avoid a wrong diagnosis of the type of epilepsy and aggravating treatment.

 

Memory dysfunction in epileptic individuals: A proof of concept in Zebrafish model

Mohmad Farooq Shaikh

Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia

Purpose: The present work provide a proof of concept that memory functions are impaired by epilepsy and anti-epileptic drugs.

Method: Zebrafish was used as a model for rapidly screening the effect on PTZ induced-epilepsy on memory functions. The impact of anti-epileptic drugs was also studied. Zebrafish’s seizure like behavior was recorded. It was also supported by biochemical and gene expression studies.

Results: PTZ induced seizure like behavior induced negative impact on the memory functions when tested using T-Maze for zebrafish. Neurotransmitters like GABA, glutamate and acetylcholine showed significant modulations.

Conclusion: PTZ induced seizure related memory dysfunction was established and it was also found that AEDs protect against PTZ induced seizure but impair memory functions further.

 

Psychiatric comorbidity in patients with two prototypes of focal versus generalized epilepsy syndromes

Imen Kacem, Fatma Laatar, Istabrak Abdelkefi, Youssef Sidhom, Mouna Ben Djebara, Amina Gargouri Berrechid, Riadh Gouider

Neurology department, UR 12 SP21, Razi Hospital, Tunis, Tunisia

Purpose: To compare the frequency of PD in two groups: patients with TLE with mesial temporal sclerosis (TLE-MTS) to patients with juvenile myoclonic epilepsy (JME).

Method: We evaluated the neuropsychological profile of patients followed-up for TLE-MTS and JME in the neurology department of Razi Hospital between 2003 and 2015. Each patient was evaluated to bring out PD. Data were reviewed and compared.

Results: We included 25 TLE-MTS and 58 JME. PD were present in 60% of TLE-MTS and in 42.8% of JME. Mood disorders (depression and anxiety) were the most frequent in both groups (44% and 46.5% respectively) and psychosis (24%-6.9%). Psychoses were significantly associated with TLE-MTS (p < 0.05). PD were associated with pharmacoresistance in TLE-MTS and JME: 69.2% and 25% respectively, with no significant association.

Conclusion: We conclude that there was a high prevalence of PD in patients with TLE-MTS and JME. Mood disorders are present in both syndromes. Psychosis was significantly associated to TLE-MTS.

 

Predictors of early atherosclerosis in young adult epileptic patients

Nesma Abd El Moneam Mohamed

Zagazig University, Zagazig, Egypt

Purpose: To assess the risk of atherosclerosis in young adult epileptic patients on antiepileptic drugs (AEDs)

Method: This study included 40 adult patients with primary epilepsy and 40 age and sex matched healthy subjects as a control group. All patients were selected as receiving AED(s) (carbamazepine and/or sodium valproate) as mono or polytherapy for at least 2 years. Patients aged from 18-45 years of both sexes. For all, Common carotid artery intima media thickness (CA-IMT), fasting lipid profile, serum uric acid (SUA), C -reactive protein (CRP) and glutathione peroxidase (GPX), were assessed.

Results: In our patients the levels of measured biomarkers versus control were TC [220.42±58.21 versus 140.00±35.09], TG [166.93±78.85 versus 93.49±35], LDL-c [141.31±43.88 versus 92.85±17.87], CRP [11.77±12.96 versus 3.82±0.63], GPX [64.31±12.17 versus 74.87±9.5], with a significant difference between the two groups.  Although uric acid levels were within the range of normal as healthy controls but VPA-treated patients (mono- and polytherapy) showed significant elevation in uric acid levels. Lower levels of HDL were detected in our patients despite the AED(s). Compared to control group, CA-IMT thickened significantly in our patients (p<0.001) especially in patients treated with carbamazepine (CBZ) [mono- and poly-therapy] than those treated with VPA. The longer the duration of AEDs the thicker was the CA-IMT (r= 0.67, p<0.001).

Conclusion: Our results suggest increased atherosclerotic risk in patients with epilepsy on AEDs

 

Seizure‐related injuries and associated factors among persons with epilepsy at regular seizure follow up clinics in Ethiopia

Yared Mamushet Yifru1, Samson Yaregal2, Adamu Addissie1

1Addis Ababa University, Addis Ababa, Ethiopia, 2University of Gondar, Gondar, Ethiopia

Purpose: Patients with epilepsy (PWE) can sustain different injuries. Severity of seizure related injuries (SRI) differ in type and their determinants. This study was conducted to assess prevalence of SRI and associated factors.

Method: Cross‐sectional retrospective survey was conducted July 1 to September 1, 2013, in seizure follow-up clinics of two hospitals in Addis Ababa. A total of 298 epilepsy patients, > 15 years of age, with unequivocal clinical and/or EEG diagnosis of epilepsy were included.

Results: Overall SRI was 38.25%; multiple-injuries (8.8%); lacerations (54.2%), burn (19.8%) and dental loss (15.8%). SRI was negatively associated with educational status (OR 0.11; 0.01-0.84). Age, sex, religion, marital status, occupation, and living situations were not associated. PWE diagnosed 6-10 years (OR 0.51; 0.27, 0.96) and 1-5 years ago (OR 0.29; 0.14, 0.58) had less chance of SRI. Last seizure within last 1 month had more SRI than seizures > 2 years ago. Last seizure 6 months to 2 years ago had less SRI (OR = 0.42 (0.20, 0.86) than seizures within last 6 months. No association obtained between SRI and onset of treatment.

Conclusion: The study documented significant levels of SRI with varied levels of severity, most commonly soft tissue and burn injuries. Associated factors were less educational status, long-standing epilepsy, and day-time attacks. We recommend increases awareness for epilepsy patients, care-givers and professionals on SRI; set up surveillance and monitoring for SRI; design interventions to reduce SRI at home, workplace and public spaces and continued advocacy on behalf of epilepsy patients.

 

Study of Prevalence of Epilepsy and Its Consequences as a Co-Morbidity in Children with Learning Disabilities

Alpana Kondekar, Surbhi Rathi, Santosh Kondekar, Mounika Reddy

Topiwala National Medical College, Mumbai, India

Purpose: There is higher association of learning disability(LD) in children with epilepsy. The study was done to find out the prevalence of epilepsy in children with LD and to examine the seizure factors and side effects of antiepileptic medications that place children at a higher risk of association with Learning Disability.

Method: In this cross-sectional study children age group 8yr-15yr who were diagnosed as learning disabled on the basis of a comprehensive developmental, psycho-educational evaluation by the expert panel were enrolled randomly and evaluated for epilepsy. Study population was divided in two groups-those with epilepsy and without epilepsy. Seizure variables like seizure control, seizure type, cause of seizure, medication status, age of onset, drugs, monotherapy v/s polytherapy were studied among these two groups.

Results: Prevalence of epilepsy in children with LD was found to be 18%. A significant association of pregnancy related complications (p=0.009, df=2) was found in children diagnosed to have LD with epilepsy. Higher occurrence of gross (p=0.002, df=1) and fine motor (p=0.031, df=1) developmental delay , significantly lower IQ was found in epileptic children with learning disability compared to children with only LD. Polypharmacy showed a relatively severe impact on cognitive function when compared with monotherapy.

Conclusion: Concurrence of epilepsy in learning disabled children put them at higher risk for further academic problems. Epileptic seizures and various side effects of antiepileptic medications may affect the cognitive function.  Referral for evaluation of LD must be advised in   those epileptic children who have academic difficulties.

 

Drug and Substance Abuse in Refractory Epilepsy

Raafat Abomandour, Maha Hazem

Mansoura University, Mansoura, Egypt

Purpose: is to study the etiology of non-response to antiepileptic drugs by estimating their serum levels and screening of drugs and substance abuse in patients with resistant epilepsy.

Method: this study was conducted in epilepsy out patient clinic, neurology department, Mansoura University Hospital. After exclusion those with organic brain lesion and who were not compliant to antiepileptic treatment, 924 patients with intractable epilepsy were included. They were subjected to:

-Toxicology screen for detection of drug and substances abuse by analysis of urine and blood samples.

-Measurements of the level of antiepileptic drugs in the blood (carbamazepine, valproic acid, phenytoin).

All assays run on the system use of homogenous immunoassay technique EMIT (Enzyme Multiplied Immunoassay Test) and confirmed by GC/MS (gas Chromatography/Mass Spectrum).

Results: Confirmed Positive results for drugs and substances abuse were detected in 246 of 924 patients (26.62%) by GC/MS. Cannabis was the first abused drug (29.27%), opiates was the second drug abused by patients (21.95%) followed by alcohol (17.88%), benzodiazepine (16.26%) tricyclic antidepressants (8.54%) and finally barbiturate constituted (6.1%). Only 17 patients show serum level of antiepileptic drugs (carbamazepine, valproate and phenytoin) within therapeutic range, but 169 patients’ levels were below it and 60 patients with levels above it.

Conclusion: Conclusions; Substances abuse may be the cause of resistant epilepsy as they are epileptogenic by themselves or due to drug-drug interaction with the antiepileptic

 

Role of Oxidative Stress, Neuroprotective Heat Shock Protein 70 and Connexin 43 in Pentylenetetrazole-induced Seizures in Rats: Possible Protective Effect of Ferulic Acid

Abdelaziz M. Hussein1, Khaled M. Abbas1, Osama A Abulseoud2

1Mansoura University, Mansoura, Egypt, 2Chemistry and Drug Metabolism, IRP, National Institute on Drug Abuse, National Institutes of Health, Biomedical Research Center, Baltimore, USA

Purpose: the present study aimed to investigate the role of Cx43 and Hsp70 in PTZ induced seizures and the effects of ferulic acid on in rat model of PTZ-induced epilepsy.

Method: twenty four Sprague dawely rats were subdivided into 4 equal groups, a) normal group (normal rats), b) PTZ group: rats received PTZ at a dose of 50 mg/kg i.p. on alternate day till the animal became fully kindled, c) FA before group, rats received FA  at a dose of 40 mg/kg daily via gastric gavage with PTZ on alternate day d)FA after group, rats  FA  at a dose of 40 mg/kg daily via gastric gavage from 6th dose of PTZ. The parameters measured were the Racine score, seizure duration and latency to develop kindling, immunohistopathological study for Cx43 and Hsp70 expression in hippocampus and hippocampal lipid peroxidation studies.

Results: In this study, PTZ caused significant increase in oxidative stress marker (MDA), Cx43 expression and Hsp70 expression in hippocamal region with significant reduction in antioxidants GSH and CAT in hippocampal region. FA pretreatment significantly reduced the seizure severity and duration kindling in PTZ treated rats and exhibited a marked prolongation in the latencies to seizures. Also, FA pretreatment caused significant improvement in markers of oxidative stress, Cx43 expression and Hsp70 expression in hippocampal region. Although FA post-treatment caused significant improvement in seizure behavior and oxidative stress and HSP70, it did not cause any significant change in Cx43 compared to PTZ group.

Conclusion: These findings may provide insights into the understanding of the mechanism of FA as an anti-kindling agent and could offer a useful support to the basic antiepileptic therapy in preventing the development of PTZ induced seizures, suggesting its potential for therapeutic applications in temporal lobe epilepsy.

 

The long-term prognosis of newly diagnosed epilepsy in Egypt: A retrospective cohort study from an epilepsy center in Greater Cairo

Ayman Ashmawi1, Hassan Hosny2, Ahmed Abdelalim2, Elisa Bianchi3, Ettore Beghi3

1Epiclue Epilepsy Clinic, Cairo, Egypt, 2Cairo University, Cairo, Egypt, 3Istituto Mario Negri, Milano, Italy

Purpose: To investigate the long-term prognosis and prognostic patterns of epilepsy in a single practice study from a developing country

Method: Consecutive patients first seen in an epilepsy clinic in Cairo, Egypt between January 1994 and December 2009 with at least 4 years of follow-up were included. Demographic, clinical, EEG and imaging findings at diagnosis were recorded. At follow-up, treatment was adjusted as clinically indicated. The response to the first drug was defined as 6-month seizure remission. Outcome measures included 2-year remission (R) and 2-year sustained remission (SR). Prognostic patterns were early (ER) and late remission (LR), relapsing-remitting (RR) course, worsening course (WC) and no remission

Results: Included were 287 patients aged 1–66 years and followed for 2237.0 person-years (mean 7.8 years). 244 (85%) attained 2-year R. The cumulative time dependent probability of R was 86.7% at 10 years. Only the response to the first drug predicted R. 82 (28.6%) attained 2-year SR. The probability of SR was 40.9% at 10 years. Poor treatment response and nocturnal seizures predicted lowered SR. R and SR were inversely correlated to the number of drugs. 208 patients (72.5%) entered ER, 36 (12.5%) entered LR, 138 (48.1%) had RR course. A WC was present in 24 (8.4%), 43 (15.0%) never entered remission. Prognostic patterns varied with neurological examination, MRI findings, pre-treatment seizure frequency, seizure type, number of seizure types, etiology, syndrome and response to first drug.

Conclusion: The long-term prognosis of newly diagnosed epilepsy patients from a developing country is in keeping with published reports.

 

Sleep generalized tonic clonic seizures in generalized genetic epilepsies

Ayman Ashmawi1, Hassan Hosny2

1Epiclue Epilepsy Clinic, Cairo, Egypt, 2Cairo University, Cairo, Egypt,

Purpose: Sleep/wake timing of seizures is associated with both epilepsy syndrome and seizure type and is attributed to genetic contribution. Sleep seizures occur more in focal epilepsy while wakefulness seizures more in generalized epilepsy (Winawer et al. Epilepsia 2016; 57: 557-565). This study aimed to explore the clinical characteristics of generalized genetic epilepsies (GGEs) patients who had generalized tonic-clonic seizures (GTCs) during sleep.

Method: We analyzed the medical records of consecutive patients with GGEs who were newly diagnosed or referred to an epilepsy clinic in Cairo, Egypt between January 1994 and December 2014. Patients included had a definite diagnosis of GGEs, had GTCs (either alone or in combination with myoclonic jerks and/or absence) and had at least 10 years follow up in the clinic. Patients with clinical or EEG focal features were excluded. The study cohort was divided into two groups, the first with sleep/wakefulness (SW) GTCs and the other with only wakefulness (W) GTCs.

Results: 102 patients were included. Mean age of onset of epilepsy (SD/range) was 14.1 years (± 4.6/ 4-30) and mean follow-up duration (SD/range) was 12.4 years (± 2.6/10-20). 15 patients (14.7 %) experienced (SW) GTCs. In univariate analysis, absence seizures (p=0.02), JAE (p=0.002) and JME (p=0.01) were significantly found in the patients with GGE who experienced (SW) GTCs.

Conclusion: One seventh of the patients with GGE not only had GTCs during wakefulness but also during sleep. This finding was significantly associated with patients who had absence seizures or diagnosed with Juvenile absence or Juvenile myoclonic syndrome

 

Challenges facing epilepsy surgery in Egypt. Past and current practice

Salah Hamada, Ahmed Darweesh

Ain Shams University, Cairo, Egypt

Purpose: Surgical management of drug resistant epilepsy has been gold standard in many developed countries for decades. Proper management requires a multidisciplinary team and an arsenal of diagnostic tools that might not all be present in the same place. We have been trying to initiate a well-structured epilepsy surgery service in Egypt. We have and still face numerous challenges to transform single surgeon based service into a comprehensive program.

Method: We review literature addressing the same topic and present our experience with different cases of drug resistant epilepsy patients that were surgically treated. We present the difficulties in case selection and surgical candidate recruitment. We discuss the operative technical difficulties that we faced and outcome of our patients.

Results: We put our recommendations for the centers with similar circumstances and wish to start an epilepsy surgery service.

Conclusion: Epilepsy patients need neurologists and neurosurgeons to work together hand in hand for a better clinical outcome positively impacting the quality of life of our patients.

 

Atypical pyridoxine dependent epilepsy resulting from a new homozygous missense mutation, in ALDH7A1

Zahraa Haidar

Saint-Joseph University, Beirut, Lebanon

Purpose: Pyridoxine dependent epilepsy (PDE) is a rare autosomal neurometabolic disorder with autosomal recessive inheritance characterized by a combination of various seizure types. Seizures are clinically refractory to conventional anticonvulsants but well responsive to daily pharmacologic doses of pyridoxine. Mutations in the ALDH7A1 gene, encoding α-aminoadipic semialdehyde dehydrogenase, within the pipecolic acid pathway of lysine catabolism, have been reported to cause this disease in most patients.

Method: Blood sampling and Whole Exome Sequencing (WES) were performed for a Lebanese child with a late-onset form of PDE. Data analysis was focused on variants within a panel of 280 epilepsy-genes.

Results: We identified a novel homozygous missense mutation in exon 2 of the ALDH7A1 gene, (p.Val80Gly). . Indeed, after confirmation of the segregation in this family of the c.239T>G in ALDH7A1, high-dose pyridoxine therapy was taken into account and the significant treatment effect is proved in the patient studied here.

Conclusion: WES and targeting genes analysis show once more their ability to put a clinical diagnosis and could be useful for defining an appropriate treatment for patients.

 

Frontal lobe epilepsy, a genetic view

Nasim Tabrizi

Mazandaran University of Medical Sciences, Sari, Iran

Purpose: Frontal lobe epilepsy (FLE) is responsible for many cases of sleep-related epilepsy. Despite the existence of symptomatic forms, the heterogenic inheritance plays an important role in pathophysiology of disease. This survey aimed to present different genetic forms of FLE and their relation to phenotype and also suggest a protocol for appropriate genetic work up of patients.

Method: In this systematic review, PubMed, Science Direct and Google scholar databases were searched by relevant keywords for time interval of 1995-2015.

Results: To date three mutations were detected in the genes coding subunits of the neuronal nicotinic acetylcholine receptor (nAChR). These genes are responsible for coding alpha-2, alpha-4 and beta-2 subunits of nAChR (CHRNA2, CHRNA4, and CHRNB2). The other loci were detected in Corticotropin releasing hormone (CRH), sodium-activated potassium channel subunit 1 (KCNT1), DEPDC5 and PRIMA1 (a transmembrane protein that anchors acetylcholinesterase) genes. Except few cases, there was no definite relation between genetic and phenotype findings. These exceptions include CHRNA4 Ser252Leu mutation which causes early onset hypermotor seizures with mild to moderate mental retardation and KCNT1 mutation with presentation of severe nocturnal FLE phenotype, early onset, high prevalence of intellectual disabilities and psychiatric or behavioral problems.

Conclusion: Genetic alteration of the cholinergic system may create an unbalanced excitation/inhibition circuitry causing seizure through the synchronizing effect of spontaneous thalamocortical oscillations. Due to different loci of mutations detected for inherited FLE, attention to semiology will help to suggest appropriate genetic work up in some cases.

 

Is interictal EEG activity linked to psychiatric disorders in temporal lobe epilepsy?

Saloua Mrabet1, Amina Gargouri1, Imen Kacem2, Istabrak Abdelkefi1, Youssef Sidhom1, Amina Nasri1, Mouna Ben Djebara1, Riadh Gouider1

1Neurorology Department, UR12SP21, Razi Hospital, Tunis, Tunisia, 2Neurology Department, UR12SP2, Razi Hospital, Tunis, Tunsia

Purpose: We evaluated interictal EEG activity and psychiatric disorders in temporal lobe epilepsy

Method: We focused on patients with temporal lobe epilepsy associated to psychiatric disorders followed in neurology department of Razi Hospital between 2002 and 2014. Clinical and neuropsychological profile, EEG data and response to treatment were documented from patients’ medical records. Psychiatric disorders were classified into depression, anxiety and psychosis. “Forced Normalisation” in EEG were evaluated in patients whose follow up duration exceeds 10 years.

Results: We included twenty seven patients among eighty patients (27/80 ≈ 33.7%) with temporal lobe epilepsy (sex ratio= 3.3; mean age: 37 years, mean age of epilepsy onset = 15 years). Disease duration exceeding ten years was found in 18 patients (66.6%). Depression was diagnosed in 16 patients (59.2 %), anxiety in 6 patients (22.2%) and psychosis in 5 patients (18.5%). Interictal EEG was normal in 17 patients (63%). It was always normal during more than ten years in 10 patients (depression: 6, anxiety: 3 and psychosis: 3). There was no significant correlation between the normality of interictal EEG and psychiatric disorder type (anxiety p=0.2; depression p=0.5; psychosis p=0.7).

Conclusion: Our results suggest an inverse relation between diagnosis and stability of psychiatric disorders and interictal EEG normality in temporal lobe epilepsy. Interictal EEG was normal in 17 patients (63 %) and persisted normal in 10 patients (37%) after 10 years of epilepsy progression. This phenomenon is known as “Forced Normalisation”. In our study, this normalization was more common in depressive disorders, whereas, this association was not significant

 

Clinical, electroencephalographic and therapeutic features of the frontal lobe epilepsy

Jihen Ketata, Amina Gargouri Berrechid, Imen Kacem, Fedia Jardak, Istabrak Abdelkefi, Amina Nasri, Mouna Ben Djebara, Riadh Gouider

Neurology Department, UR 12 SP21, Razi Hospital, Tunis, Tunisia

Purpose: To describe the clinical, electroencephalographic and therapeutic features of the frontal lobe epilepsy (FLE).

Method: We conducted a retrospective study using population-based information from medical records of patients with FLE, followed in the neurology department at the Razi Hospital in Tunis over a period of 15 years (2000-2015). We specified the demographic data, the semiology of seizures, EEG findings, neuro-psychological assessment features, etiology and response to treatment of FLE.

Results: We collected 36 patients (sex-ratio=1; mean age=36.9 years, mean age of onset= 21.3 years). The semiology of seizures was polymorphic with prevailing focal motor manifestations. Secondarily generalized seizures were noted in 44.4%, and nocturnal seizures were reported in 16% of cases. The EEG showed abnormalities in 47.2% of cases, with focal frontal or fronto-temporal topography in 27.7%. Cognitive impairment was noted in 13.8% of cases with a predominance of executive disorders. Epilepsy was symptomatic in 68.7%, probably symptomatic in 12.5% and idiopathic in 18.7% of cases. Epilepsy was controlled in 41.6% and pharmaco-resistance was found in 11% of cases, especially in symptomatic forms.

Conclusion: Our results demonstrate the heterogeneity of clinical and electrical FLE. The high rate of symptomatic forms requires a systematic imaging. A precise description of seizures, ictal and interictal EEG as well as imaging data are required to classify epilepsy and locate a potential lesion. This would contribute to the success of a possible surgical treatment in drug-resistant forms.

 

The Ongoing Challenges Meeting People With Epilepsy (PWE) and Their Treating Physicians In Developing Countries

Tahir Obeid

University of Medical Sciences and Technology, Khartoum, Sudan

Purpose: The majority of PWE reside in developing countries, and they constitute around 80% worldwide.

Despite the enormous progress made in diagnostic facilities, discoveries of recent drugs, neuro-stimulation devices and surgical treatment, yet epilepsy management is still suboptimal in developing countries.

The author will discuss the aspects and suggest some proposals to address this important issue.

Method: Review

Results: PWE in these countries are still suffering from social stigma. The expensive investigations and the necessary treatment are beyond their reach. Physicians well trained in epilepsy management are few, and the faith healers are competing with physicians in management of PWE, especially in rural areas

Conclusion: People with epilepsy are still sub-optimally managed in Developing Countries

 

Juvenile myoclonic epilepsy in Morocco: Experience of Marrakesh third level hospital

Mustapha Chaqda, Nawal Adali, Najib Kissani

Neurology Department, University Hospital Mohammed VI, Marrakech, Morocco

Purpose: The aim of this study is to describe the epidemiological, clinical, electric and therapeutic features and outcome of our patients followed for Juvenile myoclonic epilepsy.

Method: This is a retrospective study of 12 years (2004-2015) including all patients followed for JME, collected at the neurology department of the university hospital Mohammed VI of Marrakech. The diagnosis of JME was retained on clinical and electric criteria of the International League against Epilepsy. We noted epidemiological data, patient’s history, functional call signs, type and frequency of seizures and their triggers, data from the neurological examination, electroneuromyography (EMG), treatment received and outcome of patients.

Results: We collected 120 cases (56 girls and 64 boys) with a sex ratio of 1.14. The mean age of onset is 21 years, ranging from 5 to 57 years. The history of epilepsy family was noted in 36 patients and consanguinity in 22 (4 consanguineous families). The diagnostic delay is estimated at four years (+/- 2 years). Myoclonus are often associated with tonic-clonic seizures (81%), rarely absences (14%). The electroencephalogram performed in all our patients was pathological in 77%: polyspikes waves are found in 28.4%, spikes waves in 33% and focal abnormalities in 12%. The neuro-genetic study of 4 inbred families showed significant peaks on chromosome 1 (LOD score> 3.0) and on chromosome 6 (LOD score of 3.0) in one family. Monotherapy was used in 86.6% of cases (104) and the sodium valproate is the most widely used treatment. Patient follow objectified good control of seizures in 93.3% of cases.

Conclusion: Juvenile myoclonic epilepsy is a common and Benin epilepsy syndrome due to its good clinical response to monotherapy. The frequency of the EMJ in our study could be explained by the importance of inbreeding in our context. A better clinical and EEG analysis allows the diagnosis. The proper therapeutic management determines the prognosis. The genetic study keeps an important place to better enhance knowledge of EMJ.

 

Hemi convulsion- hemiplegia – epilepsy syndrome (HHE)

Kadiri Soukaina, Traoré Abdoulaye M, Kissani Najib

Neurology Department University Hospital of Marrakesh, Marrakesh, Morocco,

Purpose: Hemi convulsion- hemiplegia – epilepsy syndrome (HHE) is part of partial seizures. This syndrome has become rare in medical practice due to the preventive treatment of febrile seizures.

The objective of this work is to:

– Highlight the epidemiology, clinic, paraclinic, therapeutic and progress of HHE syndrome.

– Show that we continue to see this syndrome

Method: This is a retrospective study of 32 patients followed in neurology department of university hospital of Marrakesh for HHE syndrome, over a period from January 2010 – to December 2015. The patients included in this study respond to the definition of HHE syndrome. Data were collect from folder of hospitalized patients and the outcome register; the considered parameters were the epidemiology, clinic, paraclinic and evolution.

This is a retrospective study of 32 patients followed in neurology department of university hospital of Marrakesh for HHE syndrome, over a period from January 2010 – to December 2015. The patients included in this study respond to the definition of HHE syndrome. Data were collect from folder of hospitalized patients and the outcome register; the considered parameters were the epidemiology, clinic, paraclinic and evolution.

Results: The average age of our patients was 21 years, ranging from 12 to 30 years. In our study, hemiplegia was found in all patients. All patients had presented epilepsy. Mental disorder was found in a one patient .In neuroimaging, the majority of our patients had brain atrophy 80%.The antiepileptic treatment was based on carbamazepine in 24 patients. Favorable evolution with no residual seizures was achieved in the majority of our patients with a frequency of 84%.

Conclusion: Epilepsy during the HHE syndrome remains a good prognosis despite the existence of rare cases of drug resistance. The key treatment of HHE syndrome relies on prophylaxis.

Health development of a country is incompatible with the finding of this syndrome, which should disappear by good prevention.

Keywords: convulsion hemi-hemiplegia-epilepsy

 

Evaluation of cognitive functions and diffusion tensor imaging in patients with juvenile myoclonic epilepsy

Iman el Banhawy, Nermeen Adel

Neurology Department, Cairo University, Cairo, Egypt

Purpose: Study the cognitive performance in patients with JME and determine the evidence of neuroanatomical and neurophysiological abnormalities and its relation with cognitive function.

Method: Fifty patients with JME and a sample of healthy controls were assessed using a series of neuropsychological tests as well as diffusion tensor MRI (DTI) and tractography. DTI measures assessed fractional anisotropy (FA) within a white matter skeleton.

Results: Neuropsychological testing indicated subtle dysfunction in verbal learning and memory, phonemic and semantic fluency, attention, speed and mental flexibility. Using white matter diffusion MRI data, we found reductions in FA in underlying white matter of the left anterior corpus callosum, right supplementary motor area and left anterior cingulate. Reduced FA in the left anterior corpus callosum predicted uncontrolled generalized tonic-clonic convulsions (GTCs). As well as reduced FA in the left anterior corpus callosum and left anterior cingulate predicted uncontrolled myoclonus.

Conclusion: Patients with JME have significant frontal lobe cognitive dysfunction associated with abnormal frontal cortical and subcortical anatomical white matter impairment.

 

Epilepsia and Fahr syndrome revealing hypoparathyroidism and celiac disease: A case report

Latifa Berrhoute, Nissrine Louhab, Najib Kissani

Mohamed VI University Hospital, Marrakech, Morocco

Purpose: Show interest to seek mineral metabolism disorders in epileptic patients with Fahr’s syndrome

Method: We report the case of a patient with epilepsy and Fahr’s syndrome revealing a hypoparathyroidism and Celiac disease

Results: We describe the case of 32-year-old woman, followed for a generalized epilepsy since the age of 9, poorly monitored with underweight and chronic diarrhea since childhood, admitted to emergency for a status epilepticus. CT scan revealed a calcification of basal ganglia, labo test showed profound hypocalcemia (35 mg / l), hypoparathyroidism (1.5 pg / ml). The diagnosis of Fahr’s syndrome on primary hypoparathyroidism was retained and the patient underwent intravenous calcium correction. When switching to the oral drugs a decrease of serum calcium was observed, further, biological investigations objectified a malabsorption syndrome, Coeliac antibodies tests revealed anti-TTG IgA positive and duodenal biopsy confirmed the diagnosis of celiac disease.  A gluten-free diet was introduced with good clinical and laboratory improvement.

Conclusion: Fahr’s syndrome is characterized by bilateral and symmetrical calcification of basal ganglia, usually associated with phosphate metabolism disorders. Clinical manifestations are varied dominate by neuropsychiatric signs.

The research of calcium metabolism disorders in patients treated for epilepsy and Fahr’s syndrome  is essential for  a better therapeutic approach .

 

Reflex epilepsy in third level hospital Marrakech Morocco

Hafida ElMouden, Najib Kissani

University Hospital Mohammed VI, Marrakesh, Morocco

Purpose: The aim of this study is to describe the epidemiological, clinical, electric and therapeutic features and outcome of our patients followed for reflex epilepsy and to evaluate its frequency in third level hospital Marrakech Morocco.

Method: We reviewed the medical records of 40 patients who had been consecutively followed for Reflex epilepsy between January 2001 and September 2016 at neurology department, Med VI University Hospital of Marrakech. Included patients reply to reflex epilepsy criteria. The medical records were analyzed for the patient’s demographic details, functional call signs, type and frequency of seizures and their triggers, treatment received and outcome of patients.

Results: We collected 40 cases (28 boys and 12 girls). The mean age of onset is 23 years. 70% have no specific pathological history. The type of crisis was represented mostly by simple partial seizures with secondary generalization (65%). The seizures are provoked by visual stimulus (17.5%), a somatosensory stimulus (27.5%), an auditory stimulus (5%), taste (7.5%), complex mental processes (25%) and others (17, 5%).The electroencephalogram performed in all our patients was pathological in 40 %: focal abnormalities in 17%. Monotherapy was used in all cases and the carbamazepine is the most widely used treatment. Patient follow objectified good control of seizures in 87.5% of cases

Conclusion: Reflex epilepsies are sum of rare epilepsies with clinical manifestations, evolution and specific EEG. Their low frequency could be explained by the rarity of this entity but also by its low knowledge in daily practice.

 

Eyelid myoclonia with absences: an underdiagnosed epileptic syndrome?

Imad Yassin Saadeldin

Medeor 24×7 Hospital, Abu Dhabi, United Arab Emirates

Purpose: To identify, patients referred to our Pediatric Neurology Division, those fulfilling eyelid myoclonia with absences (EMA) criteria and to evaluate their electroclinical characteristics. In addition, to stress the role of video-EEG (VEEG) recording.

Method: Retrospective analysis of 240 patients with idiopathic generalized epilepsy (IGE). Inclusion criteria: Eyelid myoclonia with or without and absences, related to EEG generalized paroxysmal epileptiform discharges and triggered by intermittent photic stimulation and/or by eye closure

Results: 7.8% of patients with IGE could be classified as EMA.

Conclusion: EMA is not uncommon in our pediatric population. Most probably it is unrecognized by pediatric neurologists in our region due to either they are not familiar with electroclinical manifestations and/or missed when VEEGs cannot be obtained and clinical ictal phenomena are minimal or not observed during a “routine” EEG recording.

 

Particularities of epileptic spasms in non syndromic mitochondrial disorders

Nesrine Amara1, Chahnez Triki1, Emna Ellouz1, Fatma Kammoun1, Hela Zouari2, Kaouther Masmoudi2

1Hedi Chaker Hospital, Sfax, Tunisia, 2Habib Bourguiba Hospital, Sfax, Tunisia

Purpose: Epilepsy has been frequently reported in mitochondrial disorders (MD). Focal and myoclonic seizures are the most common in children. Epileptic spasms (ES), regardless of the presence or no of hypsarrythmia, have been reported in about 20% of cases. In our study, we focused on the electric and therapeutic features of ES related to MD.

Method: We investigated 5 patients with MD who presented ES. All patients have early onset progressive encephalopathy. Brain MRI and spectroscopic profile was suggestive of MD. Amino and organic acids chromatography was normal. We analyzed clinical features and reviewed ictal and inter ictal EEG.

Results: The mean age of our patients was 1.8 year. The average age of ES onset was 2 months. ES were a dominant feature in all cases. Inter ictal EEG showed hypsarrhythmia in only 3, multifocal spikes were noted in the 2 others. Ictal EEG showed sharp slow wave with fast activity. ES was pharmacoresistant to antiepileptic drug and steroids in 4 cases.

Conclusion: West syndrome has been reported in MD, however, ES without hypsarrythmia haven’t been reported yet. Our series revealed that MD can be associated to ES either with or without hypsarrythmia. Clinical and electrical pattern of ES was similar to ES of other etiologies but pharmacoresistance was more frequent in MD patients. Metabolic or genetic investigations for MD should be considered in patients with ES.

 

Epileptic Encephalopathies with myoclonic-astatic seizures in infancy

Khadija Sonda Moalla1, Fatma Kamoun1, Hela Zouari2, Emna Ellouze1, Chahnez Charfi Triki1

1Hedi Chaker Hospital, Sfax, Tunisia, 2Habib Bourguiba Hospital, Sfax, Tunisia

Purpose: Myoclonic-astatic seizures (MAS) occurred mainly in Doose syndrome, other syndromes can be considered and remain until unknown.

We analyze diverse clinical presentations of MAS that may create challenges in diagnosis and treatment.

Method: We include all patients with MAS. Their clinical, electroencephalographic findings, associated other seizure types and outcome after treatment were reviewed.

Results: Ten patients with mean age onset MAS was 33.3 months. We identified two phenotypes: Doose syndrome (G1; n=4) and unclassified epileptic encephalopathy (G2; n=6). Normal development before MAS onset was noted in all patients (G1), and only in two cases in G2. Four patients experienced several MAS daily (G2). In the two groups, analysis of the ictal EEGs (n=5) showed discharges of spike-waves or polyspike-waves at 1.5-2.5 Hz. Inter-ictal EEGs (n=7) showed frequent generalized discharges of 2-3.5 Hz spike-waves or polyspike-waves. Focal spikes and marked disorganized background activity (BA) was seen in four patients (G2) when all patients of G1 had organized BA without focal spikes. Several types of seizures were associated to MAS in all patient (G2) and two patients (G1). All patients were treated with polytherapy. In G1, three patients did not complete the follow and the remaining patient was seizure free. In G2, reduction in seizures was seen in two patients and one patient was seizure free.

Conclusion: Our study enlarges the spectrum of epileptic syndromes with MAS. Application of inclusion and exclusion ILAE criteria would differentiate it from other epileptic encephalopathies particularly Lennox-Gastaut syndrome.

 

Myoclonic absences: a misdiagnosed seizure type

Thouraya Mguidich, Fatma Kammoun, Emna Ellouz, Chahnez Triki

Hedi Chaker Hospital, Sfax, Tunisia

Purpose: In this data, we will study the main clinical characteristics of MA in our series and their prognosis

Method: Our data are based on the analysis of 8 patients diagnosed with myoclonic absences. They all undergo video EEG. We have evaluated clinical and electrical seizure semiology and response to treatment

Results: The sex-ratio was 3/1 and the seizure onset age was 4 to 9 years. Duration was under 10 seconds in 83,3%. Eyelid myoclonia was present in 5 cases, limb jerks in 3 cases and head jerks in 2 cases. Before ictal video-EEG recording, about 37.5% was diagnosed as having focal epilepsy. The interictal EEG showed a normal background activity in all cases, bilateral spikes and waves in 62.5%, synchronous spikes and waves at 3 Hz in 25% and polyspikes waves in about the third. Valproate was used in all of cases with a complete remission in 37.5% and seizure frequency reduction in 25%. Long term follow-up of patients showed clinical remission in 85.7% but EEG abnormalities persist in 71.4% after 3.1 years of follow up.

Conclusion: Myoclonic absences are characterized by marked, diffuse, rhythmical myoclonias, often associated with a progressive tonic contraction. The ictal EEG shows characteristic pattern at 3 Hz in strict relation with myoclonias recorded on EMG. Often misdiagnosed, MA can have favorable response to treatment.

 

The childhood absence epilepsy:  about 75 cases

Meriem El Mellakh, Najib Kissani, Nissrine Louhab

Department of Neurology, CHU Mohamed VI, Marrakech, Morocco

Purpose: To know the epidemiological, clinical, therapeutic and evolutionary profile of this type of epilepsy.

Method: A retrospective study about 75 cases with absence epilepsy, collected in specialized consultation of epileptology in the department of neurology, CHU Mohamed VI of Marrakech.

Results: The age of patients at the first seizure was between 9 months and 12 years with a mean of 7.1 years. There was a male predominance. Simple absences accounted for 70%. The electroencephalogram was typical in the majority of the cases. Monotherapy was the rule, with an appeal within 90% of sodium valproate, and 2.5% were well advanced in Ethosuximide. Nevertheless 7% of patients receiving combination therapy based on sodium valproate and lamotrigine. Evolutionarily, complete seizure control was achieved in 87% of cases. Monotherapy was effective in 90% of cases and combination therapy in 3% of cases.

Conclusion: The results of our study were comparable to those found in different studies published in recent years. They confirm that early diagnosis and appropriate treatment of the child’s absence epilepsy can improve the prognosis and prevent the development of complications and especially school problems that may compromise children’s schooling.

 

Transferable creative ideas for income generating projects

Nahida El Assi

Association of Care of Epileptic People in Lebanon, Sidon, Lebanon

Purpose: The purpose of the poster presentation is to share with attendees some ideas about cost-effective income-generating projects that aim at providing chances not only for epileptic people to get income and be independent, but also to their parents. More specifically, attendees will be shown a range of creative artwork ECAL has been producing and will get to know how ECAL can help them by offering seminars through online conferencing.

Method: Attendees will be shown photos of the different types of creative artwork, what preparation each project requires, what recruitment-training-marketing procedure they need to follow, and how to manage the financial aspect to benefit epileptic patients and their families.

Results: ECAL being a live example, we can explain how the income of such projects will help the association support incoming patients medically, socially, and psychologically and at the same time will reduce the risk of misusing medications or not taking medications as recommended by doctors.

Conclusion: In conclusion, epileptic patients in general and poor patients in particular need more than medical support. Otherwise, being marginalized will increase the immeasurable harm that their societies cause them.

 

Clinical Manifestation of Convulsive Status Epilepticus: a Study of 136 cases in Indonesia

Machlusil Husna, Shahdevi Nandar K, Risma Karlina, Siti Nurlaela

Medical Faculty Brawijaya University, Malang, Indonesia

Purpose: Status epilepticus (SE) is a major neurological emergency with high morbidity and mortality rate (3-46%). It is classified into convulsive (CSE) and non-convulsive status epilepticus (NCSE). CSE is the most common type and easier to recognize than NCSE. There is very little study about SE in Indonesia, so this study aimed to describe the clinical manifestation of CSE in Indonesia

Method: Convulsive status epilepticus patients, age ≥ 14 years old who were treated at Saiful Anwar General Hospital Malang from January 2011 to December 2015 were observed retrospectively. Medical records consisting clinical and demographic data were collected

Results: There were 136 patients evaluated, with male/female ratio 1.52 and majority were > 50 years old (30%). General tonic-clonic seizures were observed in most cases (80.1%) with onset > 6 hours of arrival in the emergency room (ER) (63.2%). The most common etiology was withdrawal OAE (31.6%) followed by stroke (24.3%). Patients were given diazepam (58.1%), phenytoin (89.7%) and anesthetic drugs (11.8%) and were able to overcome seizures in 61.8% of patients. Case fatality rate was 19.9%, with the most common cause of death were brain herniation (37%), septic shock (29.6%) and respiratory failure (11.1%) consecutively.

Conclusion: The majority form of convulsive status epilepticus in Indonesia is general tonic-clonic seizure form with onset > 6 hours of arrival at the ER.  Withdrawal OAE and stroke were the most important causes of CSE, with case fatality rate still remain high. We still need to improve methods in early detection and management of SE among caregivers and first line medical staffs.

 

Status epilepticus: Experience of Marrakesh third level hospital; about 121 cases.

Soukaina Kadiri, Nawal Adali, Najib Kissani

Neurology Department, University Hospital Mohammed VI, Marrakesh, Morocco

Purpose: The status epilepticus (SE) is a major emergency. It is defined as a prolonged seizure or a series of repeated seizures with an incomplete return, the duration has been changed from 30 minutes to 5 minutes according to the latest classification of the ILAE in 2015.

Method: The authors report a descriptive study over 10 years in the neurology department of the University Hospital Med VI in Marrakech. It aims to clarify the epidemiology, etiology and management of SE.

Results: We have compiled 121 cases of SE over a period of 10 years. Average age of patients was 35.3 years, ranging from 14 to 74. SE had occurred in 77% of cases known as epileptic. Seizures were generalized in 76%. Majority of our patients had first stayed in intensive care. EEG was performed in all patients and was normal in 95% of cases. Neuroimaging was normal in 70% of cases. The etiologies were dominated by lack of adherence to treatment (50%), discontinuation of treatment (14%), head trauma (13%). Antiepileptic drug frequently used was valproate sodium associated with carbamazepine. Lamotrigine was drug of choice for pregnant patients.

Conclusion: Incidence of SE is higher in patients with epilepsy. In our daily practice, physicians need to steak to SE new guidelines of the ILAE for better therapeutic approach and the prognosis. Practice of EEG plays a major role in treatment and prognosis. Prevention in epileptic patient has a major role in reducing the incidence of SE

Keywords: status epilepticus – seizure – emergency.