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Epilepsy is the commonest neurological condition affecting people of all ages, race and social class. Patients with epilepsy have two to three times higher risk of mortality compared to general population. The role of epilepsy as a potential risk factor for metabolic syndrome and coronary artery disease is of interest.To study the prevalence of metabolic syndrome among patients with epilepsy.This is a hospital based cross-sectional descriptive study. The subjects were selected from patients attending the epilepsy outpatient clinic of a single tertiary centre (GMCH, Udaipur) during the period of 15 months from January 2021 to March 2022. Fasting blood samples were drawn from them to estimate fasting blood glucose and fasting lipid profile.: Males constituted two thirds of the subjects. Average age was 32.5 years. Mean duration of treatment was 13.6 years (range 3–48 years). 51.9% were on monotherapy. Valproate was used in 33 of the 45 (73.33%) patients. In localization related epilepsy, the commonest drug was carbamazepine used in 57.48%. Eight of the enrolled patients had diabetes mellitus and 35 had impaired fasting glucose. Systemic hypertension was detected in 11.5% patients. No significant association was noted between drug use and cardiovascular risk factors – diabetes mellitus, hypertension or dyslipidemia. Very significant association was noted on lipid profile for carbamzepine, phenytoin and clobazam.Antiepileptic medications, especially valproate and carbamazepine have significant effects on the lipid profile and abdominal obesity in patients on treatment. Metabolic syndrome is more prevalent among adult patients

Objective To determine treatment responses to various antiseizure medicines (ASMs) in patients with drug resistant juvenile myoclonic epilepsy (DRJME) Methods We reviewed records of all JME patients attending epilepsy clinics at 5 centers during a 5-year period. We used International Consensus Criteria to diagnose JME and International League Against Epilepsy Criteria to define drug resistance and sustained seizure freedom. We only used broad spectrum medicines which included valproate, lamotrigine, topiramate, levetiracetam, clobazam, phenobarbitone, clonazepam, and zonisamide. We considered an ASM successful if patient achieved seizure freedom within 3 months of attaining maintenance dose. Results We studied 116 patients (61 males) with DRJME. At terminal followup, 82 (70.7%) patients had achieved sustained seizure freedom with a mean followup of 3.2 ± 1.3 years after last dose change. In patients where valproate failed as first- or second-line ASM (n=70; 60.3%), 49(70%) became seizure-free. In this group, 33(67%) patients became seizure-free after addition of lamotrigine. Success rate of lamotrigine and valproate combination was 69% as compared to 9% with all other combinations (p = 0.001). In patients who were not exposed to valproate as initial therapy (n=46), 33 (71.7%) became seizure-free, 30 (91%) after adding valproate. At last follow-up, 75 (90%) seizure-free patients were receiving valproate including 45 (55%) patients with a combination of valproate and lamotrigine. Only one of 24 patients became seizure-free after failing valproate and lamotrigine combination. Conclusion Seizure freedom can be achieved in two-thirds of patients with DRJME. A combination of valproate and lamotrigine is the most effective duotherapy.

Purpose Children with refractory focal to bilateral tonic-clonic seizures, despite normal high-resolution imaging, are often not subjected to genetic tests due to the costs involved and instead undergo multimodality presurgical evaluation targeted at delineating a focal onset. The objective of this study was to ascertain genotype-phenotype correlations in this group of patients. Method An online hospital database search was conducted for children who presented in 2019 with drug-resistant epilepsy dominated by nonlateralizing focal-onset/rapid generalized (bilateral) tonic-clonic seizures (GTCS), subjected to presurgical evaluation and subsequent genetic testing due to absence of a clear focus hypothesis. Results Phenotypic homogeneity was apparent in 3 children who had onset in infancy with drug-resistant GTCS (predominantly unprovoked and occasionally fever provoked) and subsequent delayed development. 3-Tesla magnetic resonance imaging (MRI) scans were negative and video EEG documented a homogeneous pattern of multifocal and/or generalized epileptiform discharges with phenomenology favoring probable focal-onset/generalized-onset bilateral tonic-clonic seizures. All 3 tested positive for SCN1A gene variants (heterozygous missense substitution variants in 2 children, one of which was novel and a novel duplication in one that led to frameshift and premature truncation of the protein), suggestive of SCN1A-mediated epilepsy. This electroclinical profile constituted 3 out of 25 patients with SCN1A-epilepsy phenotypes at our center. Conclusions These cases suggest that children with early-onset drug-resistant “generalized” epilepsy are likely to have a genetic basis although the presentation may not be typical of Dravet syndrome. Hence, genetic testing for SCN1A variants is recommended in children with drug-resistant MRI negative focal-onset/generalized-onset bilateral tonic-clonic seizures before subjecting them to exhaustive presurgical workup and to guide appropriate treatment and prognostication.

Background: Dopaminergic medications applied in Parkinson’s disease (PD) are associated with Impulse control disorder (ICD). Risk factors of ICD in PD include younger age, male sex and personal or family history of addiction. ICDs are under-acknowledged because of shyness or ignorance. Early detection of ICDs by correlations is of vital importance. Objectives : To estimate the point prevalence of ICD in the local cases of PD using the series of rating scales and to examine the association of various ICD manifestations in these patients. Materials and Methods: This observational study was conducted in 54 cases (parkinsonian patients) & 53 control (non-parkinsonian), who underwent Unified Parkinson’s Disease Rating Scale (UPDRS). For screening, tests like Modified Minnesota Impulsive Disorders Interview, DSM IV-RT, PDQ-39 Summary Index & various others were applied consecutively. Patients with Mini Mental state examination (MMSE) score less than 24 and those who already had mood or psychiatric disorders were excluded. A standard calculation of Levodopa equivalent daily dose (LEDD) was applied to all. SPSS 20.0 was used for various statistical tests. Results: Overall incidence of one or more ICDs among Parkinson’s disease patients was 23 out of 54 (42.59%) compared to 3 out of 53 (5.66%) in healthy control group. Hypersexuality 9(16.66%) and compulsive buying 9(16.66%) was found to be more common ICD in PD patients as compared to control. Impulse control disorders like punding, gambling, sex adventures, binge eating, impulsiveness were significantly different and worse in the Parkinson’s disease. Conclusion: PD and/or it’s treatment is more prognostic of ICDs than these ‘so-called’ harbingers like younger age, male gender or addiction. Keywords: Impulse control disorder, Parkinson’s disease dopaminergic drugs

Purpose To prospectively assess the feasibility of establishing low cost epilepsy surgery programs in resource poor settings. Method We started epilepsy surgery centers in Tier 2 and Tier 3 cities in India in private hospitals. This model is based on the identifying and operating ideal epilepsy surgery candidates on the basis of clinical history, interictal and ictal video-EEG data, and 1.5 T MRI without other investigations and without regular involvement of other specialists. Trained epileptologists formed the fulcrum of this program who identified ideal candidates, offered them counseling, and read video-EEG and MRI. We also spread epilepsy awareness among locals and physicians and established focused epilepsy clinics. The expenses were subsidized for deserving patients and policies were devised to keep video-EEG duration and staff requirement to minimum. Difficult epilepsy surgery cases were referred to established centers. Initial surgeries were performed by invited epilepsy surgeons and subsequently by local neurosurgeons. Results A total of 125 epilepsy surgeries were performed at three centers since 2012. This included 81(64.8%) temporal lobe resections, 26 (20.8%) extratemporal focal resections, and 13 (10.4%) hemispherotomies. Of the 93 patients with more than 1 year of postoperative followup, 86 (92.5%) had Engel class IA outcome. There were minor complications in 5% patients. Average cost of presurgical evaluation and surgery was Rs. 92,707 (USD 1,324). Conclusions It is possible to establish successful epilepsy surgery programs in resource poor setting with reasonable costs. This low cost model can be replicated in other parts of world to reduce the surgical treatment gap.

The fixation-off sensitivity (FOS), an epileptic phenomenon induced by elimination of central vision and fixation, is rarely seen in symptomatic occipital lobe epilepsy. The cerebral mechanisms and the structural correlate underlying FOS remain unclear. We describe a 19-year-old male with persistent left sided FOS following perinatal insult. MRI revealed asymmetric changes with more gliosis and ulegyria over the left posterior occipital cortex corresponding to the topographic representation of the macula. We suggest that the extensive denervation of the area representing macula along with the presence of hyperexitable ulegyric cortex is responsible for the phenomenon of FOS.

Photoparoxysmal response (PPR) is commonly associated with idiopathic generalised epilepsies. Most of the focal events induced by intermittent photic stimulation (IPS) are reported to be of occipital origin. Only six temporal lobe epilepsy patients have been reported in the literature with focal PPR at extraoccipital sites. We report a four-year-old girl with possible encephalitis who presented initially with epilepsia partialis continua of limbs on the right side. Interictally, she had left centro-parietal periodic lateralized epileptiform discharges (PLEDs). She responded to medical treatment and was free of seizures and motor and cognitive deficits at six months follow-up. Repeat EEG at follow-up showed left centro-parietal spikes accentuated by IPS. This is the first report of an extraoccipital, extratemporal focus showing PPR. The possible mechanism of PPR from this fronto-parietal epileptogenic focus is discussed.