Comorbidities of epilepsy.

In epilepsy management, control of seizures is the prime objective. However, the quality of life is affected by comorbid conditions that include the neurological, neuropsychiatric, and neurobehavioural disorders. These are not only reactive processes to a chronic condition but also have a bidirectional relationship, sharing common underlying pathogenesis. This article besides addressing these issues also explores the therapeutic management. A systematic search of PubMed from Jan 2006 to August 2016 was undertaken using the terms "comorbidities" and "epilepsy." In addition, articles specifically from India and other original papers were selected based on relevance. In this review, the neuropsychiatric, neurobehavioral (mood disorders, behaviour issues, attention deficits, psychosis), and neurologic [cognitive impairment, migraine, SUDEP-Sudden unexpected death in epilepsy (SUDEP)] comorbidities are covered in relation to epilepsy and its treatment. The incidental disorders such as hypertension, diabetes, and cancer that are mentioned in some reports have not been addressed here. Comorbidities in epilepsy are common but poorly understood and often remain unaddressed. The prevalence of comorbid conditions is considerably higher in epilepsy than seen in the general population and other chronic conditions. There is a wide spectrum of secondary disorders that have a marked impact and significantly increase the burden of the primary epilepsy condition. There is a need to acknowledge, screen, and intervene early in newly diagnosed cases for the optimal management of epilepsy.

The dilemma of arranged marriages in people with epilepsy. An expert group appraisal.

INTRODUCTION: Matrimony remains a challenging psychosocial problem confronting people with epilepsy (PWE). People with epilepsy are less likely to marry; however, their marital prospects are most seriously compromised in arranged marriages. AIMS: The aim of this study was to document marital prospects and outcomes in PWE going through arranged marriage and to propose optimal practices for counseling PWE contemplating arranged marriage. METHODS: A MEDLINE search and literature review were conducted, followed by a cross-disciplinary meeting of experts to generate consensus. RESULTS: People with epilepsy experience high levels of felt and enacted stigma in arranged marriages, but the repercussions are heavily biased against women. Hiding epilepsy is common during marital negotiations but may be associated with poor medication adherence, reduced physician visits, and poor marital outcome. Although divorce rates are generally insubstantial in PWE, divorce rates appear to be higher in PWE undergoing arranged marriages. In these marriages, hiding epilepsy during marital negotiations is a risk factor for divorce. CONCLUSIONS: In communities in which arranged marriages are common, physicians caring for PWE are best-equipped to counsel them about their marital prospects. Marital plans and aspirations should be discussed with the family of the person with epilepsy in a timely and proactive manner. The benefits of disclosing epilepsy during marital negotiations should be underscored.

Cerebral coenurosis mimicking hydatid disease - report of two cases from South India.

Coenurosis, a rare zoonotic disease caused by the larval form of Taenia multiceps (bladderworm) is common in sheep rearing countries, but human infections are rare. Central nervous system involvement produces large giant sized cysts that radiologically closely mimic hydatid cysts. Most human infections resulting in cerebral coenuri have been reported from Europe and Africa. We report two cases of cerebral coenurosis from India, the first in a 55-year-old male presenting with a large cystic lesion in the right parietooccipital region and the second occurring in a 36-year-old male involving the left temporal trigonal region, that radiologically closely mimicked hydatid cyst. Histopathologic examination revealed characteristic features of coenuri with multiple protoscolices invaginating into a large cyst lined by outer cuticular layer. Awareness of this rare parasitic infestation is important to discriminate from the more common hydatid and giant cysticercal cysts.

Epilepsy control with phenobarbital or phenytoin in rural south India: the Yelandur study.

BACKGROUND: Epilepsy is a controllable disorder if detected and treated early. For most families in rural areas of less developed countries, however, treatment can be delayed because of the inaccessibility of specialist neurological assessment facilities. We aimed to find a practical solution to rural epilepsy control by doing a non-randomised trial in south India. METHODS: 135 patients with partial or generalised tonic-clonic seizures agreed to long-term treatment with phenobarbital (n=68), phenytoin (n=60), or both (n=7). Drugs were given once daily, and at the lowest effective dose, by trained primary-care physicians and health workers. All management was entirely clinical. The main outcome measure was absence of seizures of any type for at least 2 years (terminal remission). Analysis was by intention to treat. FINDINGS: The proportion with terminal remission at each of 4 successive years of follow-up ranged from 58% to 66% for patients who were drug compliant and who had a lifetime total of 30 or fewer generalised tonic-clonic seizures. The corresponding range for patients who were not compliant and who had ever had more than 30 such seizures was 6-16%. Multivariate logistic regression analysis confirmed that strict drug compliance and early treatment were important predictors of a 2-year terminal remission. Clinical adverse effects were noted in three (4%) patients on phenobarbital and 67 (43%) of those on phenytoin (mainly in the form of gingival hyperplasia). INTERPRETATION: In rural areas of less developed countries, epilepsy control in its early stages can be practical and effective with existing resources. The key to success is a combination of trained primary-care physicians, health workers, inexpensive phenobarbital, drug compliance, health education, and follow-up.

The Yelandur study: a community-based approach to epilepsy in rural South India--epidemiological aspects.

Data on the epidemiology of epilepsy in a rural community in a developing country would be of value in planning a decentralized management of this malady in its early stages commensurate with available local resources. A detailed screening instrument covering various seizure types was used by trained paramedical workers in a door-to-door survey of a population of 64,963 in rural South India. The prevalence period was from 1 April 1990 to 31 March 1991. The crude prevalence rate per 1000 for active epilepsy was 4.38 for males, 3.40 for females and 3.91 for both. The minimum and maximum prevalence rates, the latter computed from a validation sample, were 3.91 and 4.63 for active epilepsy; 0.28 and 0.77 for inactive epilepsy and 4.19 and 5.41 for life-time prevalence. In addition, corresponding figures for hot-water epilepsy, a type of reflex epilepsy peculiar to this area, were 2.49 and 2.99 for active phase; 0.35 and 0.85 for inactive phase and 2.85 and 3.83 for life-time prevalence. The incidence rate for epilepsy was 49.3 per 100,000, the same as in developed countries. These data do not support the concept that the prevalence of epilepsy in developing countries is twice that in the developed world. However, the role of local/regional variations should be borne in mind before extrapolating the figures to an entire country.

Dystonia musculorum deformans with hyperuricaemia - study of a family.

This article presents a study of a family in which association of hyperuricaemia and more interestingly increased C.S.F. uric acid was noticed in two members who had classical dystonia musculorum deformans (DMD). Other members of the family had no clinical evidence of DMD but had increased serum and C.S.F. uric acid. Investigations did not reveal any of the common disorders of the purine metabolism in any of the family members. An attempt has been made to discuss the aetiopathological correlation.

Ictal confusion--an electroclinical syndrome report of three adult cases with unusual features.

Ictal confusion--an electro-clinical syndrome consisting of varying degrees of confusion with an EEG correlate of seizure activity, abolished by intravenous diazepam, is reported in three adult patients. The unusual features were 'de novo' occurrence in adults, a chronic course, focal neurological deficits and a poor response to anticonvulsants.

Cerebral cysticercosis: clinical and pathological observations with emphasis on the encephalitic type.

This paper describes clinical and pathological features in 20 cases of cerebral cysticercosis. Ten of them had clinical features suggestive of occupying lesions. In five patients (4 children and 1 adult) the disease manifested itself with headache, fever, convulsions and rapidly deteriorating level of consciousness. The onset of the disease in these patients was acute, the course short and the outcome fatal. Postmortem examination of their brains revealed cysticercus cellulosae. The pathology and pathogenesis of this rare encephalitic form of neurocysticercosis are discussed.

Study of thickened nerves in a leprosy endemic region. Part II--Ultrastructural and tease fibre study.

Ten out of sixteen cases of thickened nerves labelled as having idiopathic neuropathy showed hypertrophic changes, when their peripheral nerves were observed under light microscopy. Electron microscopy of seven nerves revealed more details. The reactions in various parameters of nerves were recorded. The significant observation was of one case harbouring Lepra bacilli as seen under electron microscope and having other changes similar to changes seen in early cases of leprosy. Two cases were also thought to have leprosy on the basis of the ultrastructural observation on their nerves. These could have been missed otherwise.

Clinical manifestations of papillary muscle dysfunction in Ehlers Danlos Syndrome.

A total of 14 cases of papillary muscle dysfunction have been observed in Ehlers Danlos syndrome. Five patients had clinically identifiable syndrome of prolapsing mitral leaflets. This form of rare interesting cardiovascular abnormality in Ehlers Danlos syndrome is discussed. The relevant literature is reviewed.