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Refractory Epilepsy (R.E.) is a condition where all antiepileptic drugs (AEDs) fail to provide adequate seizure control. To diagnose R.E., false cases of refractoriness need to be carefully excluded. There are several predictors of refractoriness. The treatment options in R.E. are resective surgery, ketogenic diet and vagal nerve stimulation. The roles of newer AEDs are also promising. The future therapeutic possibilities include deep brain stimulation, AED containing polymers, stem cells and gene therapy.

Haematological manifestations are quite common in systemic lupus erythematosus (SLE) but bone marrow aplasia and secondary myelofibrosis are rare manifestations. We report a case of 45 years old male patient who presented with fever, malaena and anaemia without any clinical features of SLE. He had patches of vitiligo for 25 years for which he was applying psoralen with sunlight exposure. This probably precipitated SLE in this patient. The patient presented with pancytopenia which was due to a combination of Comb's positive haemolytic anaemia and myelofibrosis.

Well-conducted neuroepidemiological studies for the geriatric population are rare in India. In view of the growing aging population, we planned to determine the prevalence of common neurological disorders among the elderly population in the city of Kolkata. This was a cross-sectional study of a stratified random sample of the city population and carried in two stages through house to house survey. Initially, trained non-medical workers screened the cases with a validated family questionnaire and then a neurologist examined all the screened positive cases. A validated neuropsychological screening test was also applied among the elderly population with cognitive complaints. Results showed prevalence rates (per 1000 elderly population--> or = 60 years) of following disorders in decreasing order: stroke--33.93, essential tremor--13.76, dementia--7.89, Parkinsonism--3.30 and epilepsy--2.57. Sex-specific prevalence showed that stroke was commoner among men and that of other disorders among women. Age-specific prevalence recorded progressive increase in the rates of all disorders among both genders, though not uniformly among women. Overall the crude prevalence of neurological disorders was 60.9 per 1000. The present study shows higher rate of stroke as compared to other neurological disorders among elderly population in India, which needs urgent attention.