Evaluation of one-year effectiveness of clobazam as an add-on therapy to anticonvulsant monotherapy in participants with epilepsy having uncontrolled seizure episodes: An Indian experience.

OBJECTIVES: To prospectively study the effectiveness and safety of clobazam as an add-on therapy in patients with epilepsy whose seizures are not adequately controlled with antiseizure medicine (ASM) monotherapy. METHODS: We conducted a prospective, observational study at 28 neurology outpatient clinics in India from June 2017 to October 2019. Consecutive patients with epilepsy (older than 3 years) with inadequate seizure control with ASM monotherapy were initiated on clobazam. Patients were followed up at 1, 3, 6, 9, and 12 months. Seizure control and adverse events were assessed through personal interviews and seizure diaries. RESULTS: Out of 475 eligible patients, data of 429 patients (men: 65.5%) were evaluated (46 excluded due to protocol deviations). The median age was 25 (range, 3-80 years) years and the median duration of epilepsy was 3 (0.1-30) years. The majority of patients had focal epilepsy (55.0%) and genetic generalized epilepsy (40.1%). The one-year follow-up was completed by 380 (88.5%) patients. At one-year follow-up, 317 (83.4%; N = 380) patients in the study remained seizure free. These 317 patients who were seizure free at 12 months comprised 73.9% of the evaluable population (N = 429). In 98.8% of patients, the primary reason for adding clobazam was inadequate control of seizures with treatment. During one-year follow-up, a total of 113 (22.6%) patients experienced at least one adverse event which included 103 (20.6%) patients who experienced 386 episodes of seizures. CONCLUSION: The study provides preliminary evidence that clobazam is effective and well-tolerated as add-on therapy for a period of one year among patients with epilepsy inadequately stabilized with monotherapy. TRIAL REGISTRATION NUMBER: CTRI/2017/12/010906.

An observation of impact of neurological consultations in intensive care patients: Case series of 23 patients.

OBJECTIVE: The objective of the present study was to assess the impact of neurological consultation and intervention upon patient outcome in intensive care unit (ICU). SETTINGS: A retrospective observational study was conducted in the 24-bedded multispecialty ICU of a 350 bedded tertiary care hospital over 8 months period, from January 2011 to August 2011. Critically, ill-patients with varied neurological symptomatology affecting the course of illness and ICU discharge were included. Neurological consult sought for, investigations ordered by the neurologist, interventions carried out, treatment started and the impact of such treatment on the outcome of patients were noted. The length of ICU stay was also noted. RESULTS: Over a period of 8 months, there were 864 ICU admissions. On neurological consult, 23 patients had a positive finding affecting the outcome: 5 patients were diagnosed to have parkinson's disease, 4 patients had neuromuscular disease, 9 patients had high creatinine phosphokinase levels, 2 patients had restless legs syndrome and 3 patients were diagnosed to have seizure disorder. CONCLUSIONS: On being examined and investigated by neurologist, a variety of co-existing neurological disorders could be diagnosed and if managed early, patients had a faster recovery, rapid weaning and early discharge from the ICU.

Valproate induced non hepatic hyperammonaemic encephalopathy (VNHE)--a study from tertiary care referral university hospital, north India.

OBJECTIVE: To report and discuss twelve cases of Valproate (VPA) induced hyperammonaemic encephalopathy without liver failure in subjects receiving VPA therapy. METHODS: This study was conducted in the department of Neurology, G.B. Pant Hospital, New Delhi from January 2000 to December 2006. The subjects were on treatment with VPA alone or in combination with other anti epileptic drugs and developed symptoms of encephalopathy. The data collected included the type of epilepsy, the dose of VPA and other co-administered anti epileptic drugs (AED), their serum levels, clinical presentation, relevant radiological and laboratory investigations, serum ammonia levels, the measures taken to treat the patient and their outcome. RESULTS: A total of twelve cases of VPA induced Non hepatic hyperammonemic encephalopathy (VNHE) were studied, out of which six were males and six females. The age ranged from 2-75 years with mean age of 21.33 +/- 20.84 years. Four subjects were on VPA alone and the others were also on concomitant AEDs. All the above subjects presented with either confusion or altered sensorium (100%). None of the subjects had any other demonstrable cause of encephalopathy. The serum ammonia level in these subjects ranged from 77.3-345 micromol/L with mean of 163.98 micromol/L +/- 48.67 (normal range 10-47 micromol/L). The serum VPA level in this study group ranged from 63-132.6 microg/ml with mean of 93.44 microg/ml +/- 31.77 (normal range 50-100 microg/ml). CONCLUSIONS: In any patient on VPA therapy, who develops signs and symptoms suggestive of encephalopathy, even in the presence of normal liver function, VNHE should be suspected. Fortunately, it has a good prognosis and the early withdrawl of VPA leads to improvement in almost all cases.

Cerebral venous thrombosis--clinical presentations.

Cerebral venous thrombosis (CVT) is an under diagnosed condition for acute or slowly progressive neurological deficit. CVT is less frequent than arterial thrombosis. CVT has a wide spectrum of signs and symptoms, which may evolve suddenly or over the weeks. It is clinically challenging and mimics many neurological conditions such as, meningitis, encephalopathy, benign intracranial hypertension, and stroke. With increasing awareness, CVT cases are now being diagnosed more frequently. Newer imaging procedures have led to easier recognition of venous sinus thrombosis, offering the opportunity for early therapeutic measures. It may be difficult to diagnose it on clinical grounds alone. Headache is the most frequent symptom in patients with CVT, present in about 80% of cases. Most common pattern of presentation is with a benign intracranial hypertension-like syndrome. The prognosis of CVT is worse in elderly subjects. The shorter the history the more likely is the presence of focal signs. Sixth cranial nerve palsy usually manifests as false localizing sign. Subarachnoid haemorrhage (SAH) has been described, as the presenting event with CVT. Patients may have seizures that can be recurrent. Cranial nerve syndromes are seen with venous sinus thrombosis. Psychiatric disturbances are sometimes the presenting symptoms. CVT, an important cause of stroke in puerperium, is frequently observed in India. We have seen 6 patients of CVT out of 490 stroke registry. Of these 6, four were females and two were males. The mean age among females was 27.75 years and among males was 41.5 years. Of the 4 females two were postpartum; one was on oral contraceptive and in one Antiphospholipid antibodies (APLA) were positive. Amongst two males one had hyperhomocysteinemia and one had hyperlipidemia.