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FP2-1-Ab0014
Deep Brain Stimulation As A Treatment Of Intractable Focal Onset Epilepsy: Case
Alok Gupta, Praveen Gupta, Deepak Gupta, Rahul Jain, Anurag Trivedi Artemis Health Institute, Gurgaon, India Twenty percent patients with epilepsy may be intractable to drugs. However all such patients are not good candidates for surgery specially if no lesion is identified or epileptic onset is multifocal or poorly localised. So there is need for new interventions in intractable epilepsy. SANTE study has shown a role for deep brain stimulation for focal onset epilepsy. DBS stimulation leads to interference with synchronisation and propagation of epileptiform discharges. We present the first clinical experience with DBS with anterior nucleus of thalamus stimulation in Asia. Over last year we did DBS for patients of focal onset intractable epilepsy who were refused conventional epilepsy surgery. Out of five patients 100% patients had more than 50% seizure control and 40 % were seizure free over 3-18 months of follow up. Details Our results show that DBS is clinically useful and relevant intervention as a treatment for FP2-2-Ab0020
Protective Effect Of Hesperidin Against Pentylenetetrazole (PTZ) Induced Kindling And
Associated Cognitive Dysfunction: Possible Involvement Of NO-cGMP Pathway
Anil Kumar, Sree Lalitha, Jitendriya Mishra Panjab University, Chandigarh, India Introduction- Epilepsy is a complex neurological disorder manifested by recurrent episodes of
convulsive seizures, loss of consciousness and sensory disturbances. Pentylenetetrazole (PTZ) induced kindling primarily represents a model of generalized epilepsy. Objective- The present study has been undertaken to evaluate the neuroprotective potential
of hesperidin and its interaction with nitric oxide modulators against PTZ-induced kindling and associated cognitive dysfunction in mice. Materials and Methods- Male Laca albino mice were used in the present study. The
experimental protocol comprised of eleven groups (n=6), where sub-convulsive dose of PTZ (40 mg/kg, i.p.) has been administered on every alternate days for period of 12 days, and seizure episodes were noted after each PTZ injection over a period of 30 min. The memory performance tests were carried out on day 13 and 14 followed by the estimation of biochemical Results- Chronic administration of sub-convulsive dose of PTZ resulted in an increase in
convulsive activity culminating into generalized tonic-clonic seizures, as revealed by a progressive increase in seizure score as well as alteration in anti-oxidant enzymes levels (lipid peroxidation, nitrite, glutathione, super oxide dismutase and catalase) and mitochondrial complex (I, II and IV) activities, whereas chronic treatment with hesperidin (200 mg/kg) significantly attenuated these behavioural, biochemical and mitochondrial alterations. Further, pretreatment of L-arginine (100 mg/kg) or L-NAME (10 mg/kg) in combination with hesperidin (100 mg/kg) significantly modulated the protective effect of hesperidin which was significant as compared to their effects per se in PTZ treated animals. Conclusion- The present study suggests a possible involvement of NO-cGMP pathway in the
neuroprotective effect of hesperidin against PTZ kindled mice. FP2-3-Ab0122
Clinical Characteristic of Status Epilepticus: a 10 Year Case Review in a Local Hospital
in Hong Kong
Hoi Ki Kate Lui, Hiu Tung Colin Lui, Kwok Fai Hui, Chun Tak Ip, Ip Tim Lau Tseung Kwan O Hospital, Hong Kong, Hong Kong Background: Status epilepticus is a medical emergency with high mortality and morbidity. It
poses great challenges to neurologists in managing these patients. To our knowledge, this is the first case review to analyse the clinical characteristics of status epilepticus managed in the intensive care unit in a local hospital in Hong Kong. Methods: A retrospective review of 23 patients with status epilepticus treated in the intensive
care unit in Tseung Kwan O Hospital between Jan 2003 to Jan 2013 was conducted. The demographic, clinical characteristics including potential etiology, seizure type, characteristics of EEG, pharmacological treatment of SE and complications were reviewed. Long term outcome in terms of 30 days mortality were studied. Outcomes: Of the 23 patients, 18 patients were male (78 %). The mean age was 47 (ranging
from 21 to 77 years old). Encephalitis (17 %) and hypoxic brain damage (13 %) were the main 3 patients presented with non-convulsive status epilepticus (13%) and 3 patients presented with complex partial seizure with secondary generalization (13%). The remaining patients presented with generalized tonic convulsion. Electroencephalogram studies showed lateralized epileptiform activity in 5 patients (21.7 %) and diffuse non-epileptic cerebral dysfunction in 4 patients (17 %) 5 cases showed hippocampi/ temporal involvement in MRI studies (22%). IV phenytoin was the most frequently used anticonvulsants for seizure control (95 %). 14 patients received AED polytherapy (61 %) and 10 patients received general anaesthetic treatment (43%).The commonest complication was pneumonia (26 %). The 30 days mortality rate was 13 %. The prognosis was favourable in subjects with encephalitis. Conclusions: Our analysis demonstrated that aggressive treatment for status epilepticus and
timely treatment with appropriate antibiotic, antiviral treatment and immunotherapy resulting in favourable clinical response especially for patients with status epilepticus due to underlying FP2-4-Ab0200
The Prognosis Of Acute Symptomatic Seizures After Ischaemic Stroke
Thomas Leung, Howan Leung, Yannie Soo, Vincent Mok, Cecilia Leung, KS Wong The Chinese University of Hong Kong, Shatin, Hong Kong Seizure is an important co-morbidity of stroke. There have been studies of predictive risk-factors leading up to the occurrence of first-seizure. Analysis of seizures in the clinical course of stroke is few and far between. A study of patients with acute-symptomatic seizure within 7 days of ischaemic stroke(AS) helps answer controversial questions in patients with We prospectively investigated 2925 ischaemic stroke patients from a population-based acute-stroke-unit (ASU). The stroke-related parameters were age/sex, stroke-aetiology, stroke-severity, functional disability, transient-complete occlusion or partial-recanalization, multiple-territory infarct and haemorrhagic transformation. The seizure-related outcomes were (1) Co-occurring seizures with incident stroke-episode (CS, day2-7after ischaemic stroke), (2) Another seizure in the setting of stroke recurrence (ASS, >7 days after incident-stroke with another AS and ischaemic stroke recurrence), (3) Unprovoked seizure (US,>7 days after incident-stroke without another stroke). We excluded patients with primary intracranial-haemorrhage and venous-infarcts. The incidence of AS in ischaemic stroke was 3.9% (115/2925). 104 eligible patients with AS (mean age=65 years, 55% female) had a mean National-Institute-of-Stroke-Scale (NIHSS) score of 11. Cardio-embolism was found in 48.1% (50/104) and transient-complete occlusion/partial recanalization in 30.8% (32/104). Haemorrhagic transformation occurred in 16.4% (17/104). The combined risk of CS and ASS was 28% (1-year), 30% (2-years) and 40% (8-years). The risk of developing US was 16% (1-year), 19% (2-years) and 28% (8 years). Status-epilepticus, presence of another-acute-symptomatic cause, >2 cardiovascular risk-factors were predictive of CS and ASS (p<0.05) and epileptiform-discharge for US (p=0.04). Subgroup-analysis of patients with seizure-upon-presentation did not differ in While the long-term risk of developing epilepsy after AS with ischaemic stroke was 28%, clustering of acute-symptomatic seizures are found with index-stroke or during recurrent-strokes in another 40%. This has implications for short-to-medium-term antiepileptic-drug treatment. The risk of haemorrhagic-transformation in AS/IS without thrombolysis was low. A third of patients had spontaneous recanalization of stenosis. FP2-5-Ab0203
A Survey On Antiepileptic Drug (AED) Use In A University Hospital In Hong Kong
Dr. Richard Shek-Kwan Chang, Dr. Carlin Chang, Dr. Teo Kay Cheong, Dr. Kui-Kai Lau, Dr. Jacky Chi-Yan Lee, Dr. Windsor Mak, Prof. Shu-Leong Ho Background: The Queen Mary Hospital (QMH) in Hong Kong is a university hospital serving western Hong Kong Island with a population of 500,000. The hospital manages most of the epilepsy patients living in this area. Since the emergence of the new generation AEDs, the landscape of pharmacological treatment for epilepsy has rapidly been evolving. A survey is conducted to study the out-patient AED use for epilepsy disorders in the QMH. Method: Data was retrieved through the computerized medical record system CDARS. Searching criteria included i) adults 18 year-old or above and; ii) patients who has attended any out-patient clinics from the 1st Apr 2011 to 31st Mar 2012 and; iii) diagnosed as epilepsy with ICD Code entry of 345 ‘Epilepsy’. The AEDs used by each patient within the one year Results: Total 471 patients were identified. Phenytoin (52% of all patients), Valproate (43%) and Carbamazepine (12%) are the most frequently used AEDs. Among the new generation drugs, Lamotrigine and Levetiracetam each had 10% of patients using and Oxcarbazepine and Topiramate had 7% and 2% respectively. The mean ages of patients using Phenytoin, Valproate, Carbamazepine, Phenobarbitone were 63, 49, 43, 53 respectively, while for Lamotrigine, Levetiracetam, Oxcarbazepine and Tolpiramate were 38, 42, 42 and 34 respectively. Lamotrigine use had female predominance with female: male ratio of 7:3, while other AEDs had near equal portions in both genders. Within the study period, 66% of patients were using single agent; 26% were using 2 AEDs concomitantly; 7% were using 3 agents and; 2% were using 4 agents. For concomitant drug use, the combination of Phenytoin and Valproate was the most frequent, seen in 14% among all patients. The combination of Lamotrigine and Valproate was the second most common (6%) and the combination of Phenytoin and Phenobarbital was the third (4%). Conclusion: A significant portion of studied population was still using the old-generation of drugs. The old-generation AED users tend to be of older ages. Phenytoin and Valproate combination was relatively common. The clinical, historical and socio-economical causes or rationales behind needs further study to investigate. Multi-center study within the region is required to investigate whether these phenomena commonly occurs within the region.

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