Epilepsy and behaviour

Mindfulness-based interventions (MBI) have gained prominence in addressing post-traumatic stress disorder (PTSD), offering alternative or adjunctive therapeutic approaches. On the other end, one of the possible consequences of PTSD are Psychogenic Non-Epileptic Seizures (PNES). Could long-term untreated PTSD-PNES epigenetically transform into neurological epilepsy? Would MBI still be useful as an adjunctive therapeutic approach? The references herein overviewed provide some data related to: PNES vs epilepsy, PTSD-PNES, PNES-induced epigenetic epilepsy, and finally mindfulness-based interventions (MBI) impact on PTSD symptoms, along with underlying neurobiological mechanisms potentially “transforming” PNES into real epilepsy.

In this article, the authors try to situate the comorbid and co-occurring mental and cognitive disorders associated with epilepsy within a treatment paradigm that promises an increased quality of life for children with epilepsy. Although one of the world's oldest diseases, epilepsy still carries a very high burden of disease, stigmatization and low-treatment outcome in developing nations of the world, particularly in Nigeria. Apart from physical sufferings and social embarrassment caused by seizure disorders, empirical and clinical findings show that psychological and cognitive impairments are pivotal to high burden of disease and low quality of life suffered by children with epilepsy. The best practices that promise improved methods of curative and preventive interventions for epilepsy are transor multi-disciplinary approaches, which take into account both medical and psychological problems. These approaches are known to decrease the epileptogenic focus of seizures, as well as ...

Purpose of Study: IEM are relatively rare causes of seizures in infants and children. L-serine deficiency that occurs in IEM is determined by a mutation in the genes encoding the enzymes involved in L-serine synthesis. The purpose of the study, through the example of a clinical case, was to emphasize the importance of metabolic screening evaluation of children with drug-resistant seizures for the fastest possible initiation of targeted treatment, thus preventing and minimizing the rate of complications. Materials and methods: Presentation of a clinical case of a 4-year-old boy hospitalized a lot of times in the Neurology Department of our hospital due to polymorphic epileptic seizures, resistant to combined anticonvulsant treatment (Levetiracetam, Valproic Acid, Clonazepam), associated with cognitive and verbal decline, secondary to seizures. During the genetic testing for IEM, the c.777A>T mutation was detected in exon 7 of the PSAT1 genea gene involved in the coding of the PSAT enzyme that participates in the synthesis of L-serine, thus its severe deficiency is associated with the clinical picture of our patient. Results: After the treatment with L-serine with a dose of 500 mg/kg/day divided into 3 doses, the child's condition clinically improved. Seizures disappeared after 2 months of treatment with a positive cognitive and verbal dynamics. Conclusions: Early diagnosis of seizures occurring in IEM is essential, as many IEMs are potentially treatable, and seizure control can only be achieved when they are properly treated.

Dal 1° dicembre 2008 al 12 novembre 2013 (quasi 60 mesi) ho seguito 232 anziani non autosufficienti, ospiti nella Struttura Residenziale Santa Chiara dell'Opera Immacolata Concezione di Padova. Il 23,3% o 54 ospiti furono sottoposti ad una terapia psicofarmacologica per la depressione (19 soggetti), per disturbi psicotici (18 pazienti), per disturbi comportamentali con etero-aggressività o agitazione psicomotoria (7 pazienti), per stati ansiosi (7 ospiti) ed altre diagnosi (3 soggetti). Due terzi (36 ospiti) erano femmine mentre i maschi erano un terzo (18 ospiti) ed il 74% (40 ospiti) erano ultraottantenni. Risperidone, venlafaxina, tradozone cloridrato,sertralina, paroxetina mesilato e mirtazapina sono stati prescritti per i disturbi depressivi; quetiapina e aloperidolo per i disturbi psicotici; promazina, clotiapina e perfenazina per l'aggressività e l'agitazione psicomotoria e diazepam,
lorazepam, triazolam e lormetazepam per l'ansia e l'insonnia. Si ebbero dei risultati
soddisfacenti in quanto per nessuno dei pazienti è stato necessario un T.S.O. e vi fu un solo ricovero volontario presso un S.P.D.C. (Servizio Psichiatrico di Diagnosi e Cura).
Durante la terza età, si verificano delle esperienze di "lutto" o di perdite del ruolo lavorativo e sociale, degli affetti, della memoria, della salute, dell’autonomia, dell’energia e della stima di sé. Oggigiorno, i modelli sociali ci offrono delle immagini denigratorie dell'anziano che viene spesso rappresentato d'essere consapevole e rassegnato alla sua inutilità. Una società pragmatica e poco sensibile ai problemi
esistenziali, tende a fare sentire l'anziano quasi “in colpa" per le sue limitazioni
fisiche e per i suoi vuoti di memoria. E' un facile bersaglio e lo si umilia, ricordandogli che è solo colpa sua se ha avuto l'ictus, il diabete, l'infarto ed il tumore polmonare, diventando così un ospite in una casa di riposo. Ciò è accaduto perché si è trascurato, perché ha fumato o ha mangiato troppo. Così, intimidendolo, lo si zittisce facilmente specialmente quando egli cerca di comunicare che si sente solo e che vorrebbe che i parenti gli fossero più vicini.

Methods Authors reviewed the body of research focusing on the neurobiology of panic disorder, established its plausible connection with the neurochemistry of substance abuse (alcohol, cannabis, opiates, ecstasy, and cocaine), and controlled for the consistency of findings as related to comorbidity patterns, the self-medication hypothesis and evidence of substance-induced panic disorder subtypes.

Acne vulgaris is one of the most common skin diseases in the world which affects all races and ethnicities. The highest incidence of acne exists in adolescence where 80% of all teenagers can be diagnosed with it. Occurrence is very common, affecting approximately 85% of young people. Usually its onset occurs during puberty or may appear around 25 years or older. Severity is more in males than females, lower incidence in Asians and Africans. In Unani classical literature, it is mentioned as Basoore labaniya. The present case study was planned to envisage the use of a topical Unani formulation, Zimad Irsa & Kharbaq safed in the treatment of Acne vulgaris (Basoore Labaniya). We reported a 25-year old female diagnosed with acne vulgaris. She was treated with the said intervention. Patient was evaluated before and after treatment using IGA and CADI scores. Significant improvement was seen in the patient after treatment. No adverse effects were observed during the treatment. This case study was done to highlight the efficacy of Unani drugs so as to initiate a step to develop potential herbalorigin drugs for the treatment of Acne vulgaris.

Seizures, arising from a variety of neurological conditions beyond epilepsy, pose significant health risks, including injury, prolonged episodes, and status epilepticus, which can be fatal if untreated. The SeizureShield is a cutting-edge transdermal device designed to autonomously detect and respond to all types of seizures, regardless of their origin. Using continuous EEG monitoring, the device identifies abnormal brain activity and promptly delivers a pre-loaded dose of lorazepam, a fast-acting anticonvulsant, to halt the seizure. The SeizureShield employs a miniature EEG sensor near the mastoid area for optimal seizure detection and a micro-needle array for rapid lorazepam delivery. This technology offers real-time intervention, significantly reducing the risk of status epilepticus, neurological damage, and mortality. With a 94% success rate in terminating acute seizures when administered within 10 minutes, the SeizureShield provides a life-saving solution that empowers individuals with seizures, improving their autonomy and safety, particularly in regions with limited access to timely medical care.

Background: Teaching people with epilepsy to identify and manage seizure triggers, implement strategies to remember to take antiepileptic drugs, implement precautions to minimize risks during seizures, tell others what to do during a seizure and learn what to do during recovery may lead to better self-management. No teaching programme exists for adults with epilepsy in the United Kingdom although a number of surveys have shown patients want more information. Methods/Design: This is a multicentre, pragmatic, parallel group randomised controlled trial to evaluate the effectiveness and cost-effectiveness of a two-day Self-Management education for epILEpsy (SMILE (UK)), which was originally developed in Germany (MOSES). Four hundred and twenty eight adult patients who attended specialist epilepsy outpatient clinics at 15 NHS participating sites in the previous 12 months, and who fulfil other eligibility criteria will be randomised to receive the intervention (SMILE (UK) course with treatment as usual-TAU) or to have TAU only (control). The primary outcome is the effect on patient reported quality of life (QoL). Secondary outcomes are seizure frequency and psychological distress (anxiety and depression), perceived impact of epilepsy, adherence to medication, management of adverse effects from medication, and improved self-efficacy in management (mastery/control) of epilepsy. Within the trial there will be a nested qualitative study to explore users' views of the intervention, including barriers to participation and the perceived benefits of the intervention. The cost-effectiveness of the intervention will also be assessed. Discussion: This study will provide quantitative and qualitative evidence of the impact of a structured self management programme on quality of life and other aspects of clinical and cost effectiveness in adults with poorly controlled epilepsy.

Ritalin is a methylphenidate and a stimulant of the nervous system. Its Pharmacological effects are similar to amphetamines. Ritalin is used in hyperactive children and in some cases of brain trauma usually in the form of tablets. It has been the most effective and common drug for treatment of attention-deficit hyperactivity disorder (ADHD) for years. Ritalin has a high potential for abuse, particularly in some students use it to increase focus in order to success in exams. Use of high-dose Ritalin via intravenous and inhalation or intranasal administration can cause many complications similar to cocaine and amphetamine. These complications include violent behavior, hallucinations, hyperexcitability, irritability, panic, and psychosis. In some animal models, structural damage to the nervous system and other organs has been reported. So, distribution and usage of Ritalin should accurately be controlled and monitored to prevent its abuse.

Abstract: An article establishes assessment of quality of life, severity of seizures and emotional condition 117 patients with
epilepsy, over the age of 18 (35.13±1.19) with different form epilepsy what started from 0 to 69 years (14.22±1.26) in the
Machtagа village. How showed analyzes of the survey results, the patients sub clinic 62 (52.9%) and clinic 29 (24.8%)
pronounced measure depression and anxiety from scale Ziqmond and high measure severity of seizures from national hospital
seizure severity scale (NHS3) (20-27 scores bу 54 (46.1%), (3-9 scores by 40 (34.2%) patients, adversely affecting to their
quality of life, assessment by questionnaire «QOLIE-10» (27.1±0.3). Social status research revealed a high patients
unemployment rate (82 (70.1%) p=0.911). Between 70 (59.8%) disability patients most had secondary group (р=0.938). The
number of lower secondary education and uneducated patient prevailed among native (28 (36.8%)/7 (9.2%)) and nonnative (11
(26.8%)/4 (9.8%)) village population (р=0.547). In population research 65 (55.6%) patients were married, 52 (44.4%) patients
were alone (р=0.386). During the study it was revealed influence of ethnocultural characteristics patients to measure quality of
life. A form of expression of religious beliefs, which, in the form of a clear implementation of the established religious rules,
had a positive effect on the quality of life of patients from the hunhar and kechan mehelle, and mysticism in relation to religion,
a form of upbringing in a family without encouraging intellectual development, and even prohibitions on obtaining an
education, contributed to the formation passive personality with disabilities among patients from seidler mehelle, which
affected their QOL negatively.
Keywords: Epilepsy, The Quality of Life, National Hospital Seizure Severity Scale, Ethnocultural Features

Background: Traumatic brain injury (TBI) is a significant medical concern, with post-traumatic epilepsy (PTE) being one of its consequences. Epilepsy, with a global prevalence of 1%, is the third most common neurological disorder after stroke and Alzheimer’s disease. Trauma accounts for 20% of symptomatic epilepsy cases. Understanding the prevalence of PTE and the factors influencing it can aid in diagnosis and treatment. This study aims to investigate the relationship between epilepsy prevalence, age, gender, and post-traumatic brain injuries.
Methods: This retrospective descriptive study analyzed data from 135 epilepsy patients hospitalized between 2018 and 2021. Statistical analysis involved reviewing relevant data and creating tables and graphs.
Results: The findings indicate that epilepsy is more prevalent in men than in women, with the most affected age group being 20-29 years old. Post-traumatic epilepsy emerged as the most common factor among the patients. The prevalence of PTE in this study was 9.6%, closely aligning with the global rate of 7.8%.
Conclusion: The prevalence of post-traumatic epilepsy is significantly influenced by geographical conditions and living environments. In developing countries, the high volume of road traffic and increased accident rates contribute to a higher incidence of post-traumatic epilepsy.

Background: Female gender has been described as a major risk factor for depression, thus, a double problem for women with epilepsy (WWE) because the higher likelihood of developing depression. Objective: The purpose of this study was to determine the prevalence of depression and the factors that contribute to it, as well as to compare clinical characteristics between depressed and non-depressed WWE. Methods: This study was designed as a case control study involving one hundred (100) WWE and fifty (50) healthy controls aged 16 years and above. Zung Self-Reported Depressive Scale (ZSRDS) was used to assess the mood, while cognitive status was assessed using the Cognitive Screening Instrument for Dementia (CSID). Results: The mean age of patients and mean age of onset of depression were 29.07±7.55 and 20.01±11.57 respectively. There was a significant difference between the Carbamazepine (CAR) and Levetiracetam (LVC) groups with regards to the mean score of total CSID score (p0.000) and its sub domains which are Language (p0.012), Memory (p0.000), Orientation (p0.035), and Attention and Calculation (p0.000). There was a statistical significant difference between depressed and not depressed groups with regards to memory (p0.000), orientation (p0.003), attention and calculation (p0.000) and total CSID (p0.000). There was a statistically significant difference between mean ZSRDS of participant with focal, generalized and no epileptiform pattern (p0.003). However, only attention and calculation predict depression (p0.010) Conclusion: The mean ZSDRDS score was higher among those women with epilepsy compared to controls. Furthermore, the mean ZDRDS score was higher in carbamazepine compared to levetiracetam group.

Background: Teaching people with epilepsy to identify and manage seizure triggers, implement strategies to remember to take antiepileptic drugs, implement precautions to minimize risks during seizures, tell others what to do during a seizure and learn what to do during recovery may lead to better self-management. No teaching programme exists for adults with epilepsy in the United Kingdom although a number of surveys have shown patients want more information. Methods/Design: This is a multicentre, pragmatic, parallel group randomised controlled trial to evaluate the effectiveness and cost-effectiveness of a two-day Self-Management education for epILEpsy (SMILE (UK)), which was originally developed in Germany (MOSES). Four hundred and twenty eight adult patients who attended specialist epilepsy outpatient clinics at 15 NHS participating sites in the previous 12 months, and who fulfil other eligibility criteria will be randomised to receive the intervention (SMILE (UK) course with treatment as usual-TAU) or to have TAU only (control). The primary outcome is the effect on patient reported quality of life (QoL). Secondary outcomes are seizure frequency and psychological distress (anxiety and depression), perceived impact of epilepsy, adherence to medication, management of adverse effects from medication, and improved self-efficacy in management (mastery/control) of epilepsy. Within the trial there will be a nested qualitative study to explore users' views of the intervention, including barriers to participation and the perceived benefits of the intervention. The cost-effectiveness of the intervention will also be assessed. Discussion: This study will provide quantitative and qualitative evidence of the impact of a structured self management programme on quality of life and other aspects of clinical and cost effectiveness in adults with poorly controlled epilepsy.

Background: Epilepsy is the third world neurological disorder. Epileptic focus causes motor impairment by sending projections to different areas of the brain such as areas which are related to movement control. Regarding the inhibitory effect of low-frequency electrical stimulation (LFS) on seizure wave's transmission, this study aimed at examining the effect of LFS during the epileptogenesis of dorsal hippocampal on balance and locomotor activity in adult male rats using the kindling method. Materials and Methods: Fifty rats were randomly divided into 5 groups: Control, Sham, Kindled, LFS and KLFS. Animals in the kindled group were stimulated rapidly by daily stimulation of dorsal hippocampus (1 ms pulse duration at 50Hz for 3 seconds). Animals in the sham and control groups did not receive any stimulation. In the LFS groups, four LFS packages at a frequency of 1 Hz were applied daily. At the end of stimulation, motor activity and balance were assessed by open-field and rotarod...

Background: Patients and carers increasingly access the Internet as a source of health information. Poor health literacy is extremely common and frequently limits patient's comprehension of health care information literature. We aimed to assess the readability of online consumer-orientated stroke information using 2 validated readability measures. Methods: The 100 highest Google ranked consumer-oriented stroke Web pages were assessed for reading difficulty using the Flesch-Kincaid and Simple Measure of Gobbledygook (SMOG) formulae. Results: None of the included Web pages complied with the current readability guidelines when readability was measured using the gold standard SMOG formula. Mean Flesch-Kincaid grade level was 10.4 (95% confidence interval [CI] 9.97-10.9) and mean SMOG grade 12.1 (95% CI 11.7-12.4). Over half of the Web pages were produced at graduate reading levels or above. Not-for-profit Web pages were significantly easier to read (P 5 .0006). The Flesch-Kincaid formula significantly underestimated reading difficulty, with a mean underestimation of 1.65 grades (95% CI 1.49-1.81), P , .0001. Conclusions: Most consumer-orientated stroke information Web sites require major text revision to comply with readability guidelines and to be comprehensible to the average patient. The Flesch-Kincaid formula significantly underestimates reading difficulty, and SMOG should be used as the measure of choice.

La Neurocisticercosis es la enfermedad parasitaria más frecuente del Sistema Nervioso Central (SNC). Es una zoonosis con una alta prevalencia en los países subdesarrollados en donde las malas condiciones ambientales y la crianza y convivencia con cerdos predispone a su aparición. Aunque la prevalencia de esta enfermedad es desconocida en Venezuela, se presentan casos esporádicos en los hospitales de la región. En este estudio descriptivo y retrospectivo, se reportan las manifestaciones clínicas de presentación de 15 pacientes que asistieron al Instituto Autónomo Hospital Universitario de Maracaibo, estado Zulia en los últimos 10 años. Los pacientes se diagnosticaron por Tomografía Axial Computarizada (TAC) y Resonancia Magnética (RM). 10 pacientes fueron de sexo masculino y 5 de sexo femenino. El grupo etario más afectado fue el de 30 a 44 años (43%). Las manifestaciones clínicas más frecuentes fueron: cefalea (27%), convulsiones (20%), visión borrosa (13%), nauseas y vómitos (13%), mareos y vértigos (13%), pérdida de la conciencia (7%) y pérdida de la fuerza muscular (7%). Estas últimas manifestaciones no se reportan en la literatura, por lo que hay que tener en cuenta a la Neurocisticercosis cuando se realice el diagnóstico diferencial.

Recent anatomical and DTI data demonstrated new aspects in the subcortical occipito-temporal connections. Although a direct (inferior longitudinal fasciculus, ILF) pathway has been previously described, its fine description is still matter of debate. Moreover, a fast and direct subcortical connection between the limbic system and the occipital lobe has been previously recognized in many functional studies but it still remains poorly documented by anatomical images. We provided for the first time an extensive and detailed anatomical description of the ILF subcortical segmentation. We dissected four human hemispheres with modified Klingler's technique, from the basal to the lateral occipito-temporal surface in the two steps, tracking the ILF fibers until their cortical termination. Pictures of this direct temporo-occipital pathway are discussed in the light of recent literature regarding anatomy and functions of occipito-temporal areas. The dissection confirmed the classical originating branches of ILF and allowed a fine description of two main subcomponent of this bundle, both characterized by separate hierarchical distribution: a dorsal ILF and a ventral ILF. Moreover, a direct pathway between lingual cortex and amygdala, not previously demonstrated, is here described with anatomical images. Even if preliminary in results, this is the first fine description of ILF's subcomponents. The complex but clearly segregated organization of the fibers of this bundle (dILF and vILF) supports different level of functions mediated by visual recognition. Moreover, the newly described direct pathway from lingual to amygdala (Li-Am), seems involved in the limbic modulation of visual processing, so it may support physiological conditions the crucial role of this connection in human social cognition. In pathological conditions, on the other hand, this may be one of the hyperactivated pathways in temporooccipital epileptic and nonepileptic syndromes.

Background. Much attention is paid in the literature to the psychological profiles associated with ostomies, but until 2022 there was a lack of a psychoclinic instrument that was able to investigate all 9 individual subjective functions possibly impaired by the ostomate condition and the degree of impairment. For this reason, "Perrotta-Guerrieri Psychological Care for Ostomy Patients" (PCOP) was developed for all clinical phases, in 45 items with an L1-5 response scale, for the study of quality of life in the ostomized patient, which was also able to offer from the therapist a holistic understanding of the problem in all its phases (pre-operative, operative, postoperative, follow-up), integrating a patient-specific clinical intervention protocol. Materials and Methods. Clinical interview and battery of psychometric questionnaires. Results. Of 58 patients (M: 57.3 years), divided into two groups (CG and Cg) of equal distribution, the group in which the protocol was applied (CG) achieved quantifiable benefits to the extent of 50-75% individually and 97% in the total group. Conclusions. PCOP is a psychoclinical tool that can offer therapists the opportunity to explore the issue of patient quality of life and best focus on the most appropriate and targeted clinical intervention.

Context: Trigeminal nerve stimulation (TNS) is a promising non-invasive brain stimulation intervention. The TNS has been proposed for major depressive disorder (MDD) with auspicious results. The aim of this study was to review the literature on TNS for MDD. Evidence Acquisition: Systematic review, using MEDLINE and EMBASE, of first articles available until 22nd of April 2016. Results: We included seven studies; six of them were open-label studies and one sham-controlled randomized double-blinded trial. Most studies had small sample sizes. Two studies were on MDD with comorbid posttraumatic stress disorder and one study focused on the elderly population. Two different protocols of stimulation were reported. Studies had interesting positive results for treating MDD. Conclusions: The TNS was reported to be well tolerated, with no severe adverse effect reported, and had impressive results for MDD. This promising, safe and easy-to-use new neuromodulation technique could be a useful tool for MDD treatment. However, the results reported in the studies performed so far must be analyzed under the strict limitations of the study design. Most of the studies on TNS are case studies or open-label trials with very small sample sizes. We acknowledge that it is the time to initiate more rigorous sham-controlled trials to better understand the huge potential involved with this technique, which could lead to the development of more accessible, easy-to-use, safe and non-invasive technology.

Background: Falij-e-Nisfi (Hemiplegia) is one of the major neurological disorder usually caused by the occlusion of blood vessels to atherosclerotic thrombosis and embolism .other Causes are cerebral hemorrhage; neoplasms and infections. Methods: A Clinical study to assess the effect of MUNZIJ (concoction) and MUSHIL (purgation) internally along with DAL'K (Massage) and RIYAZATH (exercise) externally was conducted on 24 patients in the

Background: Falij-e-Nisfi (Hemiplegia) is one of the major neurological disorder usually caused by the occlusion of blood vessels to atherosclerotic thrombosis and embolism .other Causes are cerebral hemorrhage; neoplasms and infections. Methods: A Clinical study to assess the effect of MUNZIJ (concoction) and MUSHIL (purgation) internally along with DAL’K (Massage) and RIYAZATH (exercise) externally was conducted on 24 patients in the inpatient department of  Dr. Ahmed Ashraf Memorial Unani Specialty Treatment Center for paralysis, Hyderabad; a Center of Excellence by Ministry of AYUSH, Govt. of India. Results: The Observations of the Study indicated that in between 55 to 65 years of age; the disease is more common. In this Study 46% of cases showed good response; 12% of cases Showed poor response. Conclusions: These results indicated that further more study would be carried out to provide a clean picture.

Background Levetiracetam and zonisamide are licensed as monotherapy for patients with focal epilepsy, but there is uncertainty as to whether they should be recommended as first-line treatments because of insufficient evidence of clinical effectiveness and cost-effectiveness. We aimed to assess the long-term clinical effectiveness and cost-effectiveness of levetiracetam and zonisamide compared with lamotrigine in people with newly diagnosed focal epilepsy. Methods This randomised, open-label, controlled trial compared levetiracetam and zonisamide with lamotrigine as first-line treatment for patients with newly diagnosed focal epilepsy. Adult and paediatric neurology services across the UK recruited participants aged 5 years or older (with no upper age limit) with two or more unprovoked focal seizures. Participants were randomly allocated (1:1:1) using a minimisation programme with a random element utilising factor to receive lamotrigine, levetiracetam, or zonisamide. Participants and investigators were not masked and were aware of treatment allocation. SANAD II was designed to assess non-inferiority of both levetiracetam and zonisamide to lamotrigine for the primary outcome of time to 12-month remission. Anti-seizure medications were taken orally and for participants aged 12 years or older the initial advised maintenance doses were lamotrigine 50 mg (morning) and 100 mg (evening), levetiracetam 500 mg twice per day, and zonisamide 100 mg twice per day. For children aged between 5 and 12 years the initial daily maintenance doses advised were lamotrigine 1•5 mg/kg twice per day, levetiracetam 20 mg/kg twice per day, and zonisamide 2•5 mg/kg twice per day. All participants were included in the intention-to-treat (ITT) analysis. The per-protocol (PP) analysis excluded participants with major protocol deviations and those who were subsequently diagnosed as not having epilepsy. Safety analysis included all participants who received one dose of any study drug. The non-inferiority limit was a hazard ratio (HR) of 1•329, which equates to an absolute difference of 10%. A HR greater than 1 indicated that an event was more likely on lamotrigine. The trial is registered with the ISRCTN registry, 30294119 (EudraCt number: 2012-001884-64). Findings 990 participants were recruited between May 2, 2013, and June 20, 2017, and followed up for a further 2 years. Patients were randomly assigned to receive lamotrigine (n=330), levetiracetam (n=332), or zonisamide (n=328). The ITT analysis included all participants and the PP analysis included 324 participants randomly assigned to lamotrigine, 320 participants randomly assigned to levetiracetam, and 315 participants randomly assigned to zonisamide. Levetiracetam did not meet the criteria for non-inferiority in the ITT analysis of time to 12-month remission versus lamotrigine (HR 1•18; 97•5% CI 0•95-1•47) but zonisamide did meet the criteria for non-inferiority in the ITT analysis versus lamotrigine (1•03; 0•83-1•28). The PP analysis showed that 12-month remission was superior with lamotrigine than both levetiracetam (HR 1•32 [97•5% CI 1•05 to 1•66]) and zonisamide (HR 1•37 [1•08-1•73]). There were 37 deaths during the trial. Adverse reactions were reported by 108 (33%) participants who started lamotrigine, 144 (44%) participants who started levetiracetam, and 146 (45%) par ticipants who started zonisamide. Lamotrigine was superior in the cost-utility analysis, with a higher net health benefit of 1•403 QALYs (97•5% central range 1•319-1•458) compared with 1•222 (1•110-1•283) for levetiracetam and 1•232 (1•112, 1•307) for zonisamide at a cost-effectiveness threshold of £20 000 per QALY. Cost-effectiveness was based on differences between treatment groups in costs and QALYs. Interpretation These findings do not support the use of levetiracetam or zonisamide as first-line treatments for patients with focal epilepsy. Lamotrigine should remain a first-line treatment for patients with focal epilepsy and should be the standard treatment in future trials.

A principal causa de Epilepsia do Lobo Temporal Mesial (ELTM) e a Esclerose Mesial Temporal (EMT). De inicio, geralmente na adolescencia, a ELTM causa crises com automatismo tipico de lobo temporal, que frequentemente afetam a funcao da memoria. O objetivo e realizar uma revisao atualizada sobre o tema, trazer para discussao topicos de correlacao entre EMT e ELTM, no que se referem a meios para se chegar ao diagnostico e tratamentos utilizados. Foi realizada uma pesquisa exploratoria, com levantamento de artigos no Scielo e LILACS por meio de palavras-chave. Nos resultados, pode-se compreender que a EMT caracteriza-se por uma esclerose hipocampal com perda neuronal e gliose no exame histopatologico. O diagnostico se da a partir de exames como a Ressonância Nuclear Magnetica (RNM) e Video-Eletroencefalograma (Video-EEG). O tratamento clinico obtem otimas respostas e, quando refratario, opta-se pelo cirurgico, como a Amigdalo-hipocampectomia seletiva, tambem com boas respostas

Acne vulgaris is extremely common dermatological disorder, affecting more than 85% of adolescents and young adults. In western societies, acne vulgaris is a nearly universal skin disease afflicting 79% to 95% of the adolescent population. A recent systematic review of the epidemiology of acne across the world noted acne prevalence estimates ranging from just over 20% to over 95%. The greatest burden of acne globally is between the first and third decade of life and almost certainly causes embarrassment, stigma, shame, guilt, and low self-esteem, which are likely to cause psychosocial problems. It is characterized by both inflammatory (papules, pustules and nodules) and non-inflammatory comedones (open and closed) lesions. In Unani system of medicine, acne vulgaris is termed as busoore labaniya that are whitish eruptions on the nose and face that represent milk droplets or frozen ghee (Roghan zard) due to Ma’dah sadidiyah or pus like morbid matter that is directed towards the skin for...

Background: On the subject of couple relationships, the literature pays attention to clinical, socioanthropological profiles and psychological issues related to the capacity to love, empathy, satisfaction and happiness; however, there is a lack of a psychometric tool that can address the issue of couple stability in a structured and organized manner from an emotional-affective perspective. Objectives. To develop and adjust a psychometric tool that can be efficient and effective in solving the analysis of a coefficient of couple relational stability. Materials and Methods: Clinical interview, based on narrative-anamnestic and documentary evidence, and battery of psychometric tests. Results: In CGa, those who scored more than 20% differential at PLS-Q1 were 58/118 (69%), while in CGb they were 118/118 (100%). In therapy, in the CGa, the resolved cases were 58/58 (100%), while in the CGb, the resolved cases were 110/118 (93%). At the clinical interview, it was found that the 8/118 (7%) "resistant" patients had, according to the PICI-3 model, a diagnosis of borderline personality disorder (5/8, 63%), histrionicnarcissistic (2/8, 25%), and bipolar (1/8, 12%), and thus by their nature not very prone to therapeutic adherence. Conclusions: Perrotta Love Stability Questionnaire (PLS-Q1) is a psychometric tool that offers therapists the opportunity to explore the topic of couple relationship stability, helping them to better focus on patients' vulnerable emotional positions to construct the most appropriate and targeted clinical intervention.

Abstract

Introduction: Pediatric neuroimaging presents a unique set of challenges, primarily stemming from the intricacies of normal myelination processes occurring within the initial two years of life. This complexity is particularly pronounced in the context of pediatric epilepsy, where a substantial proportion of neuroimaging cases appears normal, especially in instances of idiopathic or provoked seizures. Nevertheless, abnormalities in neuroimaging tend to manifest in cases of acute or remote symptomatic seizures. Notably, the etiological landscape of seizures in children diverges significantly from that observed in adults, with neurodevelopmental, neurometabolic, and neuro-infectious factors emerging as predominant contributors.
Methodology: This multicentric study, conducted between November 2021 and November 2023, spanned diverse hospitals across various states in India. Encompassing children from birth to 12 years of age experiencing acute and remote symptomatic seizures, the study meticulously documented clinical and demographic profiles. Exclusion criteria were applied, excluding typical febrile seizures and idiopathic epilepsy syndromes to ensure a focused analysis.
Results: The study encompassed a total of 109 cases, revealing a spectrum of neuroimaging findings. Noteworthy among these were cortical malformations, including focal cortical dysplasia (12 cases), tuberous sclerosis (6 cases), polymicrogyria (3 cases), hemimegalencephaly (1 case), lissencephaly (1 case), schizencephaly (2 cases), heterotopias (3 cases), cavernous hemangioma (1 case), and AV malformation (1 case). Additionally, neoplastic lesions (6 cases), neurocysticercosis (5 cases), tuberculoma (4 cases), hippocampal sclerosis (3 cases), post-hypoxic and cerebrovascular accident gliosis (3 cases), leukodystrophies (2 cases), and non-lesional cases (58 cases) were documented.
Conclusion: Pediatric neuroimaging in symptomatic seizures may present with normal findings, influenced by interpreter bias and the non-uniform availability of 3T MRI across different medical centers. The diverse causative factors for symptomatic seizures underscore the impact of demographic features, including the endemicity of specific infections and birth injuries, on the observed variability across medical centers. These findings underscore the imperative for a comprehensive understanding and standardization in pediatric neuroimaging practices

Oxcarbazepine in a monotherapy trial for partial seizures-Placebo-controlled studies in neurology: Where do they stop? To the Editor: The editorial by Drs. Chadwick and Privitera 1 that accompanied our report of a placebo-control monotherapy trial of oxcarbazepine for partial seizures 2 carries forward the recent spirited discussion in the literature about the design and importance of monotherapy studies in epilepsy. 3-5 However, we feel compelled to respond to their assertions concerning the clinical value and ethics of our study. Was our study clinically valuable? Absolutely. Because of its placebo-controlled design, our study convincingly established the antiseizure activity of oxcarbazepine. This demonstration has significant value because proof of efficacy is justifiably essential for a drug to be licensed in the United States. In addition, our study showed that oxcarbazepine can be safely titrated over one day and that its antiseizure effects begin rapidly. This finding is meaningful to clinicians because of the paucity of other controlled studies that show antiepileptic drug (AED) efficacy in an acute setting. Was our study ethical? The principal investigators, coinvestigators, and sub-investigators, all of whom were associated with leading academic medical centers, as well as their institutional review boards and their clinical research center scientific advisory boards (where applicable) would not have otherwise performed or approved this study. However, Chadwick and Privitera argue that our study compromised two of Beauchamp and Childress' principles of medical ethics-beneficence and nonmaleficence 6-and their balance, or equipoise. 7 We strongly disagree. Equipoise existed in our study because beneficence for oxcarbazepine had not been previously established, in our opinion. Yes, oxcarbazepine is indeed widely licensed for the treatment of epilepsy in Europe and is structurally similar to carbamazepine. But in this era of evidence-based medicine, how convincing is the previously published data that oxcarbazepine is effective? As clinicians, we agree that comparative monotherapy trials, such as the widely influential Veterans Administration Cooperative Study, 8 are more relevant to the practical day-today care of patients than placebo-controlled trials such as ours. We further agree that more such studies are needed. However, the study design of comparative trials must be suitable to allow the antiseizure effects of each treatment to be observed. Otherwise, doctors can not reasonably conclude that a new treatment is more or less effective than an old one. Whether the published double-blind, comparative oxcarbazepine studies satisfy this study design requirement is debatable. They consisted of trials in which patients were randomized to oxcarbazepine or existing standard treatment, and then the proportions of seizure-free patients during the treatment period were compared. 9-13 None of these studies were placebo-controlled, and none showed that oxcarbazepine had superior efficacy compared with another active treatment. Most significantly, the actual effectiveness of oxcarbazepine or the other treatments relative to the underlying likelihood of spontaneous seizure remission during the treatment phase is unknown for each of these trials because none of them included an untreated control group. This consideration is particularly important when patients with newly diagnosed or newly treated epilepsy are studied, as was true for all but one of the oxcarbazepine studies. 9-11,13 As noted by Chadwick and Berg, there is evidence from developing countries to suggest that half of all cases of epilepsy spontaneously remit regardless of length of treatment or whether treatment is given at all. 14 Compare that figure to the 56% to 61% of patients receiving oxcarbazepine who were seizure free in three of the double-blind comparative studies of patients with newly diagnosed or treated seizures. 9-11 Second, we strongly take issue with Chadwick and Privitera's inference of the maleficience of our study. Regrettably, patients with epilepsy are at risk for dying from their seizures, whether they are inpatient or outpatient, whether they are undergoing a medication taper, and whether they are participating in a monotherapy or add-on study. Certainly, the incidences of sudden unexpected death among patients undergoing a surgical evaluation 15 and adults attending an outpatient epilepsy tertiary referral center 16 are higher than in the general epilepsy population. However, we are unaware of any evidence that the risk of mortality for patients with intractable seizures is greater during an admission for seizure localization than at other times. Nonetheless, clinicians must be sure, as were those involved with this study, that the potential benefit of surgery and the risks of further, uncontrolled seizures outweigh the risks of an inpatient evaluation. The pertinent question is whether participation in our study put patients under additional, incremental risk. We believe that careful attention to patient selection, strict adherence to the exit criteria, and continuous observation and EEG monitoring minimized any additional risks to study subjects. In support of this contention, none of the nearly 100 patients with medically intractable seizures enrolled in our study suffered status epilepticus, and none died. Chadwick and Privitera make the additional argument that our study was inconsistent with the Helsinki Declaration on Human Rights because our patients were not ensured the best proven therapeutic method. In fact, the Helsinki Declaration also addresses diagnostic methods, which is more relevant to presurgical evaluations. Our study subjects were patients for whom the best therapeutic methods had not historically provided a satisfactory quality of life. They underwent presurgical evaluations because their seizures were refractory to conventional AEDs and had their AEDs tapered as per standard accepted practice. The goal of their presurgical admissions was to localize seizure onset, not to provide better therapy. During the trial, they continued to receive the best proven diagnostic method given their circumstances-EEG monitoring-while participating in a drug study that they believed might eventually result in a new treatment for seizures. Do all comparative monotherapy studies, as advocated by Chadwick and Privitera, adhere to the Helsinki Declaration? Clearly, some do. But given the potential for injury, death, and psychosocial disadvantages from seizures, one could challenge the ethics of a study in which outpatients with active seizures are given drugs as monotherapy that have never been proven in a double-blind study to work better than a placebo or a comparator. Are those patients receiving the best proven therapeutic method? Our study was clinically valuable and ethical. Based on our experience with this trial, we do not wonder whether placebocontrolled studies in neurology should be stopped, as do Chadwick and Privitera. We advocate that more be commenced

Purpose: Acute symptomatic seizures (ASyS) are common in critically ill patients. It is unknown how ASyS affect posthospitalization self-reported health compared to patients with established epilepsy. Methods: This is a retrospective cohort study from 2010 to 2018. Patients were identified by an institutional epilepsy database (Ebase). Patient-reported outcome measures (PROMs) were completed as part of standard of care and included the number of seizures in the prior 4 weeks, Liverpool Seizure Severity Scale (LSSS) ictal score, quality of life in epilepsy (QOLIE)-10, Patient Health Questionnaire-9 scales, and the PROM Information System Global Health (PROMIS-GH) scale. Mixed-effects models were created to adjust for age, sex, and race and to examine score trajectory over the 1 year after baseline. Results: A total of 15 311 established epilepsy patients and 317 patients with ASyS were identified. When compared to patients with epilepsy, patients with ASyS were older, mostly male, mo...

Objective: We aimed to determine the therapeutic drug monitoring (TDM) features and the relation to Brain-Derived Neurotrophic Factor (BDNF) of frequently used new antiepileptic drugs (NADs) including lamotrigine (LTG), oxcarbazepine (OXC), zonisamide (ZNS) and lacosamide (LCM). Moreover, we investigated their effect on the quality of life (QoL). Methods: Eighty epileptic patients who had been using the NADs, and thirteen healthy participants were included in this cross-sectional study. The participants were randomized into groups. The QOLIE-31 test was used for the assessment of QoL. We also prepared and applied "Safety Test". HPLC method for TDM, and ELISA method for BDNF measurements were used consecutively. Results: In comparison to healthy participants, epileptic participants had lower marriage rate (p=0.049), education level (p˂0.001), alcohol use (p=0.002). BDNF levels were higher in patients with focal epilepsy (p=0.013) and in those with higher education level (p=...

Objective: To compare the efficacy of Unani formulation in chronic endocervicitis. Methods: A parallel, comparative randomized trial was conducted at Govt. Nizamia General Hospital, Hyderabad from 1998 to 2000 in 50 patients (25 in each group) with sign and symptoms of endocervicitis. The intervention was administered per oral and locally for 10 d from day 7 to day 16 of each menstrual cycle up to three consecutive months in both groups (A and B). Group A received 10 g powder of mako khusk, chobchini, and gul surkh with equal quantity of sugar orally, twice daily and locally douching with 100 ml of joshandae of barge neem (5g), and gule tesu (5g) was done per vaginum followed by insertion of humool (pessary) of loabe khatmi (5g), and safoof sadberg (3) mixed with roghan neem (10 ml). Group B received 7.5 g powder of ushba and kasni mixed with equal quantity of sugar orally, twice daily. Humool of loabe hulba (5g), and raswat (3g) with roghane gul was kept per vaginum. The outcome was inter-group comparison of effectiveness of Unani medicine by observing change in subjective and objective parameters of endocervicitis. Chi-square/Fisher Exact tests were carried out to observe the inter group comparison. Results: The demographic characteristics were statistically not significant (P>0.05) between the groups. No statistical difference was noted in the subjective and objective parameters of endocervicitis (P>0.05), showing that both groups were comparable. Conclusion: Group A and B were comparable in ameliorating sign and symptoms of endocervicitis because of anti-inflammatory, analgesic and antimicrobial effects. Further, randomized controlled trials are recommended.

Anisoon, Pimpinella anisun is a plant which belongs to umbellifera family. In unani medicine it is also known as anisun. It is usually grown for its seeds (aniseeds). It isan annualgrassyherb. Since centuries its extract of seed it has been used in unani medicine which is a colorless and pale-yellow liquid in nature which has a particular odor and taste. It contains 1.5 to 3.5% volatile oil, 10% fixed oil, protein mucilage and starch. Anisun oil is also used an essential oil which contains transethanol methyl chavicol anisaldehyde estragole coumarins scopoletin umbelliferon estrol etc. Its therapeutic uses in unani medicineare in sailanur reham (leucorrhea), sudade jigar wa tihal masana wa rahem, istisqa (ascites), bawasir specially bawasir e rehi (piles), qillate laban (insufficiency of lactation), darde shikam (abdominal pain), dama (asthma), nazla (common cold), laqwa (facial palsy), istarkhaeye (paralysis), dawar (vertigo) this present article reviews about all unani literature ...

Sudden health states accompanied by seizures require proper diagnosis and appropriate treatment. A seizure in the paediatric population may turn into a life-threatening condition, especially when it is misdiagnosed and appropriate management is initiated too late. The article presents the classification of seizures proposed by the International League Against Epilepsy and seizure time intervals when appropriate treatment should be implemented. The main part of this work is the description of non-pharmacological treatment. In this paper, the management of seizures in the paediatric population was based on the guidelines proposed by several recognised organisations. The American Epilepsy Foundation is one of the bodies publishing guidelines for the management of seizures in the paediatric population. This organisation recommends treatment based on the STAY-SAFE-SIDE strategy. According to these guidelines, the patient should not be left alone, all objects that may injure the patient d...

Se describe el caso clínico de una paciente de 41 años de edad con antecedentes de cefalea migrañosa, que se había agudizado durante el primer semestre del 2012, quien fuera ingresada en el Hospital Clinicoquirúrgico Docente "Dr. Ambrosio Grillo Portuondo" de Santiago de Cuba, luego de haber sido estudiada por diferentes especialistas y no mostrar signos de mejoría. Al realizársele la resonancia magnética nuclear de cráneo, se observaron imágenes compatibles con neurocisticercosis, de modo que se comenzaron a aplicar los medicamentos adecuados para curar esta infestación. Actualmente la paciente continúa bajo tratamiento médico.

Background: Epilepcy is a chronic neurological disease, and due to its complex mechanism, the current therapeutic drugs for it are not effective enough. It may have a non-neurological origin such as astrocytes and microglia. Objective This study aims to investigate the effect of cabergoline and levetiracetam (alone or combined) on the histological and stereological structure of the cerebral cortex, hippocampus, and cerebellum in rats with pentylenetetrazol (PTZ)-induced seizure. Methods: In this experimental study, samples were 30 female rats in five groups of control, seizure (PTZ-induced kindling), seizure+levetiracetam, seizure+cabergoline, seizure+levetiracetam+cabergoline. Levetiracetam and cabergoline were used at 50 and 0.05 mg/kg doses, respectively, and half of these doses were used in the seizure+levetiracetam+cabergoline group. After anesthesia, animals’ brain tissue was removed and after preparing tissue slices, the number of neurons and neuroglia was examined using ster...

Background: Pre-op anxiety has adverse effects on the patient's anesthesia and treatment. Currently, electrical interventions are widely used as non-invasive methods to control pre-op anxiety and may have advantages as compared with medical therapies. This study aimed to determine the effect of transcranial alternating current stimulation on anxiety and hemodynamic response of patients undergoing surgery. Materials and Methods: This study enrolled 50 patients undergoing surgery with anesthesia class (Ι). Before surgery, the experimental group received a transcranial alternating current stimulation for 20 min. The control group underwent a sham electrical stimulation. The post-test was done 2 hr after the intervention and before surgery. The independent t-test, Chi-square and Kolmogorov-Smirnov tests were used to compare groups. The data were analyzed by SPSS v.16. Results: There were no significant differences in demographic variables between the groups. Patients' anxiety level was not significantly different before the intervention between the groups. However, anxiety level of the experimental group was less than that of the control group after the intervention (P= 0.005). The pre-op systolic blood pressure and heart rate were less in the experimental group as compared with the control group (respectively P<0.001, P=0.001). A positive and significant correlation was observed between two variables of anxiety level and the pre-op need for information (P=0.00). Conclusion: The results of the present study indicated that transcranial alternating current stimulation is effective on reducing pre-op anxiety and stability of hemodynamic response of patients. Furthermore, training patients and furnishing them with information before surgery can reduce their anxiety.

Background: Ischemic heart disease (IHD) also known as coronary artery disease (CAD) is the leading cause of death worldwide. IHD is caused by obstruction of one or more coronary arteries. Among the various causes of obstruction atherosclerosis is the leading cause. Physical inactivity, smoking, saturated fat rich diet, hypertension, diabetes mellitus, dyslipidaemia are modifiable risk factors for atherosclerosis which ultimately results in IHD. In this article we will discuss the disease in the light of Unani system of Medicine and how to manage it depending on the understood concepts Methods: A number of classical Unani textbooks were referred for description of various heart diseases and various search engines such as PubMed, Google Scholar and Research Gate were cited for recent advancements using the key words IHD, atherosclerosis, cardio-protective herbal drugs, etc. Conclusion: Owing to the irreversible damage due to IHD it is better to prevent myocardium damage by minimising...

Patient non-adherence to prescribed anti-epileptic drugs (AEDs) remains a challenge to successful treatment of patients with epilepsy. However, the literature on epilepsy does not document a comprehensive review of interventions to improve adherence as a means to improve clinical outcomes. This study systematically reviews existing literature on interventions to enhance AED adherence and clinical outcomes, and the measures of adherence included in these studies. We selected randomized controlled trials (RCTs) of interventions to enhance adherence with AEDs, which also measured clinical outcomes, with at least 80% follow-up of participants for at least 6 months, from a comprehensive Cochrane review of adherence interventions for medications, complete to January 2013, and updated searches for additional AED studies in multiple bibliographic databases to January 2016. Two review authors independently extracted all data and a third author resolved disagreements. The present update inclu...

Dislocation of temporomandibular joint (TMJ) secondary to a seizure is rare. We report the case of a 32-year-old woman, who presented with a left TMJ dislocation during a status epilepticus. The airway was protected until reduction. A bimanual relocation by Nelaton's manoeuvre was attempted successfully.

Simple and complex visuomotor performance of the right and left sides of the body was investigated in 37 children with left hemisphere lesions, 35 children with right hemisphere lesions, 53 developmentally dyslexic children, 29 developmentally hyperactive children, and 35 "nonnal" children who had endured a very mild head injury with no sequelae. Background: Lateralized soft signs, EEG topography, metabolic brain imaging, and neuropsychological test profiles suggest a predominance of left hemisphere dysfunction in dyslexia and right hemisphere dysfunction in hyperactivity. Method: Nine measures of lateralized performance were drawn from the Purdue pegboard, Letter cancellation, Rey complex figure, Wechsler Intelligence Scale for Children (WISC) Mazes, and WISC Picture completion tests. Results: The children with left hemisphere lesions manifested significantly weaker petformance on test components involving the right body side, relative to the normal controls, on the Purdue pegboard, Rey complex figure (delayed recaU condition), and WISC Picture completion tests, and the dyslexic children on the former two. The children with right hemisphere lesions manifested significantly weaker perfor mance on test components involving the left body side, relative to the normal controls, on the WISC Mazes test, as did the hyperactive children. Conclusions: We propose that (I) contralat eral performance decrement results from a unilateral cortical lesion in children, and (2) devel opmental dyslexia may comprise a slight predominance of left hemisphere dysfunction and developmental hyperactivity of right hemisphere dysfunction. (NNBN 2000;13:89-100) UNILATE RAL PERFORMANCE DECREMENT AND HEMINEGLECT When a unilateral performance decrement is purely sen sory, it is termed hemianopsia (vision), or hemianesthesia (somesthesia). When it is purely motor, it is termed hemi paresis or hemiparalysis. However, a unilateral percep mal, complex motor or perceptuomotor perfonnance dec rement observed on a background of preserved sen ation or motricity is termed hemin.eglect. All these deficits are caused by a unilateral lesion contralateral to the deficit.

Falij-e-Nisfi (Hemiplegia) is a condition in which there is loss of movement and sensation in longitudinal half of the either side of the body. It is the commonest form of paralysis, occurring due to stroke or cerebrovascular accident. Stroke is the leading cause of disability worldwide and second most common cause of death. Post stroke hemiplegia is most common causes of disability in adults. In India its prevalence is 56.9 per 100,000.Unani scholars from various part of the world have been treating the condition of Falij-e-Nisfi (Hemiplegia) since centuries successfully. Different effective regimes are available in Unani system of medicine (USM) for the treatment of Falij-e-Nisfi (Hemiplegia). Those treatments are effective and having fewer side effects. In the present paper the case studies of two female patients suffering from Falij-e-Nisfi (Hemiplegia) due to stroke treated with Unani formulations is reported.This case series documented the successful treatment and prevention o...

Epilepsy is one of the chronic neurological disorders with an incidence rate of 3% in the normal population. Epilepsy may render behavioral changes so that affected people are prone to prolonged interpersonal difficulties. In order to evaluate co-morbidities and potential personality changes, the study was conducted among the patients with epilepsy in an Iranian population. The study was a cross-sectional one with a convenience sampling method. The data of 74 patients with epilepsy and 74 non-epileptic patients were collected by clinical interview and Millon clinical multiaxial inventory (MCMI-III) and were analyzed by SPSS software. The average age was 31.70. The highest scores gained in epileptic patients were in narcissistic 14.04 (4.53%), obsessive 14.26 (4.30%), and negativistic domains 14.15 (5.24%), while histrionic 76.38 (28.54%) and obsessive 61.74 (24.03%) patterns were obtained in non-epilepticpeople. There were significant differences between the two groups in all areas except for the debasement index (Z score) and the negativistic personality disorder. There was a significant positive correlation between narcissistic and obsessive personality patterns and posttraumatic stress disorder with education, as well as between sex and drug dependency. Economic and marital status showed correlations with schizoid personality and sadistic personality, respectively. Patients with tonic-clonic seizures have although difficulties in personality (negativistic) and clinical syndrome areas but the results showed lower scores in subscales except for disclosure (X index) compared with non-epileptic individuals. They are more inclined to disclose the problems with worse mental health conditions than non-epileptic people.

Objective Our aim is to assess the types and frequency of seizure-related injuries and to determine their effects on Quality of Life (QoL). Methods Fifty-seven patients with epilepsy were included to our study. The demographic and clinical data of all the participants were recorded. All patients completed the Quality of Life in Epilepsy Inventory 89 (QOLIE-89). Injury types were classified as burns, head trauma, dental traumas, fractures, body injuries, penetrating traumas, road injuries, and drowning. Results Forty-two patients had seizure-related physical injury history whereas 15 of them declared no history of injury. Lower education levels and more frequent seizures were associated with higher seizure-related injury rates (p < 0.05). The most common types of seizure-related injuries were head trauma (22%) and fractures (17%). Fifty-seven (64%)of the injuries took place at home. There was no difference in QOLIE-89 scores between patients with or without seizure-related injury. Multiple injuries, admission to emergency, older than 20 years of the first seizure-related injury, and shorter than 10 years after last seizure-related injury are negatively effective on the QoL scores. Conclusion Patients with epilepsy are likely to have seizure-related injuries which may be severe but do not affect the patients' QoL. Seizure-related injuries most commonly occur at home and therefore simple precautions (supervised bathing, using microwave ovens instead of classical stoves, avoiding electric irons and electric heaters, and sleeping close to the floor to avoid falling) taken to reduce the incidence of seizure-related injuries will help reduce hospitalizations and will also be cost-effective.

1 рГБоу вПо «Чувашский государственный университет им. и.н. ульянова», Чебоксары; 2 университет Тромсе, Тромсе, норвегия; 3 университетская клиника Северной норвегии, Тромсе, норвегия; 4 Больница нурланда, Будё, норвегия Приведено описание клинического случая судорожных приступов у мужчины в возрасте 40 лет, который проходил обследование и лечение у неврологов и психиатров на протяжении 15 лет. из-за низкой эффективности лечения и постоянного ухудшения состояния пациент утратил трудосопособность. Первоначальный диагноз психогенных неэпилептических приступов был дополнен диагнозом биполярного аффективного расстройства ii типа. лечение ламотриджином привело к улучшению состояния пациента, что расценено как позитивное воздействие на органические изменения в головном мозге, находящиеся в связи как с аффективными, так и эпилептическими нарушениями.