Outcome of epilepsy surgery in lesional epilepsy: Experiences from a developing country.

BACKGROUND: Our aim was to report the postoperative seizure outcome and associated factors in patients with lesional epilepsy, in a low-income setting. METHODS: This longitudinal prospective study included patients who underwent epilepsy surgery at Kashani Comprehensive Epilepsy Center between 2014 and 2019. Post-surgical outcomes were reported according to the Engel score, and patients were classified into two groups of seizure free (SF) and not-seizure free (NSF). RESULTS: A total of 148 adult patients, with a mean age of 30.45 ±â€¯9.23 years were included. The SF outcome was reported in 86.5% of patients and antiepileptic drugs (AEDs) were reduced or discontinued in 45.9%. The mean follow-up duration was 26.7 ±â€¯14.9 months. Temporal lobe lesions (76.3%) and mesial temporal sclerosis (MTS) (56.7%) were the most frequent etiologies. Temporal lesion (Incidence relative risk (IRR): 1.76, 95% CI [1.08-2.87], p = 0.023), prior history of CNS infection (IRR:1.18, 95% CI [1.03-1.35], p = 0.019), use of intra-operative ECoG (IRR:1.73, 95% CI [1.06-2.81], p = 0.028), and absence of IEDs in postoperative EEG (IRR: 1.41, 95% CI [1.18-1.70], p < 0.001) were positive predictors for a favorable outcome. CONCLUSION: Many patients with drug-resistant lesional epilepsy showed a favorable response to surgery. We believe that resective epilepsy surgery in low-income settings is a major treatment option. The high frequency of patients with drug-resistant epilepsy in developing countries is associated with high rates of morbidity and mortality. Hence, strategies to increase access to epilepsy surgery in these settings are urgently needed.

The Effect of Pregabalin and Metformin on Subacute and Chronic Radiculopathy.

BACKGROUND: Radicular pain is one of the most common forms of chronic pain in the world, which has challenges about effective medical therapy. The aim of this study was to evaluate the effect of pregabalin (PGB) and metformin (Met) on subacute and chronic radiculopathy. MATERIALS AND METHODS: This double-blind prospective clinical trial was performed on 71 patients with subacute and chronic cervical and lumbosacral radiculopathy. Group A was treated with PGB 75 mg daily while Group B was treated with PGB 75 mg daily and Met 500 mg daily for 3 months. Finally, the pain score in both groups was evaluated based on visual analog scale (VAS) and numerical scale pain. RESULTS: The results showed a significant reduction in VAS and pain severity in both groups but this reduction in the terms of VAS (47.79% vs. 46.48%, P = 0.125) and pain severity (47.1% vs. 39.2%, P = 0.264) was more in treated patients with PGB and Met as compared to PGB group while total pain experience (53.5% vs. 49.1%, P = 0.464) and interference with daily function (57.1% vs. 50.61%, P = 0.726) were more in patients treated with PGB alone. CONCLUSION: Our results showed that PGB and PGB + Met reduced pain intensity and interference with daily function while we did not observe significant differences between two groups. PGB alone would have the potentiality to become a simple and economic means to decrease radicular pain.