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0142 Evaluation of the hypothalami of women with epilepsy and reproductive dysfunction using 1H-MRS
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Monday, November 7, 2005
Breast feeding is common practice and most of them breast fed their children till the child reaches two years of age. Most of them have enlarged spleen. Conclusion: It is interesting to note that low prevalence of epilepsy in these tribals is probably due to their late weaning or dietary habits or they may be protected by some immune mechanism which is directly or indirectly influenced by malaria. 0141 Levetixacetam add-on therapy in our patients with ret~aeto~y partial epilepsy Nezadal, T ~, Hovorka, J, Nemcova, I, Herman, E, Bajacek, M.
1Neurology, Epileptology and Neuropsyehiatry Department, Na FrantisTcu Hospital, Prague, Czech Republic Backgxound: Levetiracetam (LEV) is a newer arttiepileptic drug (AED) licensed for the add-on therapy of partial epilepsy. In our open-label prospective - naturalistic study we followed up the efficacy and tolerability of LEV in patients with 'high frequency" refractory partial seizures with/without secondary generalization. Methods: 53 patients (125 female and 28 male) entered the study, in the mean age of 33.5 ± 9.1 years, with refractory partial epilepsy and high frequency partial seizures. The mean seizure frequency per month was: total (129.8), SPS (10.4), CPS (118.4), secondary GTCS (10.9). Patients were receiving one or 2 other AEDs in at least 1 month stabile dosage before LEV add-on therapy. The follow-up period was 4 months, during which no changes of baseline AEDs were made, and then the long term drug safety evalution started (2 years). We evaluated the seizure frequency reduction, adverse events and the presence of new amxiety and depressive symptoms (using psychiatric scales H A M A 17 for amxiety and H A M D 21 for depression) both at baseline and study end. Results: Levetiracetam mean daily dosage was 2291.7 ± 617.4 mg and 48 patients completed the study (retention rate was 90.5%). 21% (N -- 11) of patients achieved seizure freedom, the responder rate (_>50?,'o seizure frequency reduction) was 49%. The significant main seizure reduction was relatively prompt in the first month of therapy. 3 pts. were discontinued due to the treatment unefficacy. Mild to moderate adverse events were observed in 26% (N - 14) patients, leading to therapy discontinuation in 5.7% (IN -- 3) of patients. 4.2% (IN - 2) patients experienced mild anxiety and depressive symptoms in HAMA, H A M D scales. In 4 patients (responders) we found mild signs of iritability and insomnia, 3 of these patients were also treated with lamotrigine. There were no psychiatric, reasons for LEV treatment discontinuation in our patients' group. The long term safety will be discussed and statistical evaluation will be presented. Conclusions: Our study results confirm the good and prompt efficacy, good tolerability and the lack of "de novo'" psychiatric symptoms of levetiracetam add-on therapy in patients with refractory and frequent partial seizures. 0142 Evaluation of the hypoilmlami of women with Epilepsy and ~eproductive dysfunction using rH-MRS Nikolov, B ~, Harden, C 1. 1Weill Medical College at Cornell University,
New York, USA Background: The aim of this study was to detemfine if women with epilepsy and early onset menopause have abnormal neuronal integrity of the hypothalamus as measured by proton-magnetic resonance spectroscopy (all-MRS). It is known that frequent interictal seizure disruption of the hypothalamus may lead to reproductive endocrine disorders in women. The hypothalamus is an integral part in the regulation, production and secretion of reproductive hormones. MRS may confirm hypothalamic abnormalities that are manifested through
Poster Abstracts early onset menopause in women with epileptic seizures in comparison to age matched controls. MeillOd: 5 women presenting a history of epilepsy and early menopause were studied along with a set of age matched controls. All data were acquired on a 3.0 Tesla Eclipse GE MRI scmmer using a transmit/receive head coil. A 512x512 T~ weighted coronal series was prescribed along the anterior/posterior commissure line to localize the base of the third ventricle and place the mxial MRS slices. A multi-slice 2D-CSI sequence from the NIH (J. Duyn, J.W. van der Veen) was used to prescribe 3 slices having a 32x32 grid size and a 7.5x7.5x15 mm voxel size. The PRESS based sequence used a sweep width of 1000 Hz, 256 points, a T R of 2300 ms and a TE of 280 ms for a scan time of 30 minutes. Spectra were transferred to an SGI Octane workstation for analysis using X s O s N M R software (IX. Mac, D.C. Shungu). Low-pass Hanmffng and Fermi k-space filters removed lffgh frequency noise components prior to FFT. A low-frequency Gaussian function was convolved with and subtracted from the data to remove the residual water signal. Data were zero-filled in time, to 512 points, and space to yield a 64×64 grid. Voxel shifting was performed prior to FFT in order to place a single CSI voxel on the center o f each side of the hypothalamus. A representative spectrum referenced N A A at 2.02 ppm and this spectrum was then used as a reference for susceptibility corrections applied to the entire grid. The correlation coefficient between each spectrum and that of the reference spectrum was minimized to eliminate spectral shifts between voxels. Peak areas were integrated between fixed ranges to obtain NAA, CRE and CHO values in ratio to RMS noise. Results: Metabolic ratios of NAA/CRE, N A A / C H O and CHO/CRE were calculated for the hypothalamus comparing values from the right side against the left as well as between the patient and control populations. In addition, ratios for the total hypothalamus were calculated and compared with normal grey matter within the same slice. N o significant variatimas in metabolic ratios between patient and control populations were observed. 0143 Epilepsy in rural Cameroon: the alarming prevalence rates in the Mbam valley Njamnshi, A r~, Dongmo, L ;, Sini, V ~, Echouffo, B;, Kamdem, P;, Pepouomi, M 2, Atchou, A 2. ~Central Hospital Yaounde-Neurology
Service, Cameroon; 2Faculty Of Medicine And Biomedical Sciences, University of Yaounde 1, Cameroon Background and Purpose: The epidemiology of epilepsy in Cameroon (Central Africa) has not been well described. A team from the Faculty of Medicine and Biomedical Sciences Yaounde, began a series of studies to determine the epidemiological, clinical, aetiological and therapeutic features of the condition and to propose strategies to fight against the disease in Cameroon, as a contribution to the worldwide fight against epilepsy. Patients and methods: Door-to-door surveys using the WHO/IENT criteria, have been carried out in 4 villages (total sample size of 8398 individuals) of the Mbam valley, situated about 135 kan north of Yaounde, to establish the descriptive epidemiology of epilepsy. Results: The prevalence rates of epilepsy in the four villages studied thus far have been 11.6%o for Yebekolo (sample studied* -- 2500), 27.0%o for Ossah (* - 2000), 49.0%0 for Bilomo (* -- 1898) and 60.5%o for Badissa (* - 2000). The general prevalence in the total sample studied (18398 individuals) was 35.4%o. The most affected age group was that from 10 to 29 years: 265 of 297 epileptics (89.2%). "rite sex ratio was 1.2 in favour o f males. Generalised tonic-clonic seizures were the most frequent seizure type: 223 (175.1%). Conclusions: These data obtained in the Mbam valley of Cameroon are alarming and call for an urgent concerted effort, both at the national and international levels to further investigate the aetiological and other factors involved. Tiffs would contribute towards building art effective healthcare system that would eventually control tiffs serious malady.
Monday, November 7, 2005
Breast feeding is common practice and most of them breast fed their children till the child reaches two years of age. Most of them have enlarged spleen. Conclusion: It is interesting to note that low prevalence of epilepsy in these tribals is probably due to their late weaning or dietary habits or they may be protected by some immune mechanism which is directly or indirectly influenced by malaria. 0141 Levetixacetam add-on therapy in our patients with ret~aeto~y partial epilepsy Nezadal, T ~, Hovorka, J, Nemcova, I, Herman, E, Bajacek, M.
1Neurology, Epileptology and Neuropsyehiatry Department, Na FrantisTcu Hospital, Prague, Czech Republic Backgxound: Levetiracetam (LEV) is a newer arttiepileptic drug (AED) licensed for the add-on therapy of partial epilepsy. In our open-label prospective - naturalistic study we followed up the efficacy and tolerability of LEV in patients with 'high frequency" refractory partial seizures with/without secondary generalization. Methods: 53 patients (125 female and 28 male) entered the study, in the mean age of 33.5 ± 9.1 years, with refractory partial epilepsy and high frequency partial seizures. The mean seizure frequency per month was: total (129.8), SPS (10.4), CPS (118.4), secondary GTCS (10.9). Patients were receiving one or 2 other AEDs in at least 1 month stabile dosage before LEV add-on therapy. The follow-up period was 4 months, during which no changes of baseline AEDs were made, and then the long term drug safety evalution started (2 years). We evaluated the seizure frequency reduction, adverse events and the presence of new amxiety and depressive symptoms (using psychiatric scales H A M A 17 for amxiety and H A M D 21 for depression) both at baseline and study end. Results: Levetiracetam mean daily dosage was 2291.7 ± 617.4 mg and 48 patients completed the study (retention rate was 90.5%). 21% (N -- 11) of patients achieved seizure freedom, the responder rate (_>50?,'o seizure frequency reduction) was 49%. The significant main seizure reduction was relatively prompt in the first month of therapy. 3 pts. were discontinued due to the treatment unefficacy. Mild to moderate adverse events were observed in 26% (N - 14) patients, leading to therapy discontinuation in 5.7% (IN -- 3) of patients. 4.2% (IN - 2) patients experienced mild anxiety and depressive symptoms in HAMA, H A M D scales. In 4 patients (responders) we found mild signs of iritability and insomnia, 3 of these patients were also treated with lamotrigine. There were no psychiatric, reasons for LEV treatment discontinuation in our patients' group. The long term safety will be discussed and statistical evaluation will be presented. Conclusions: Our study results confirm the good and prompt efficacy, good tolerability and the lack of "de novo'" psychiatric symptoms of levetiracetam add-on therapy in patients with refractory and frequent partial seizures. 0142 Evaluation of the hypoilmlami of women with Epilepsy and ~eproductive dysfunction using rH-MRS Nikolov, B ~, Harden, C 1. 1Weill Medical College at Cornell University,
New York, USA Background: The aim of this study was to detemfine if women with epilepsy and early onset menopause have abnormal neuronal integrity of the hypothalamus as measured by proton-magnetic resonance spectroscopy (all-MRS). It is known that frequent interictal seizure disruption of the hypothalamus may lead to reproductive endocrine disorders in women. The hypothalamus is an integral part in the regulation, production and secretion of reproductive hormones. MRS may confirm hypothalamic abnormalities that are manifested through
Poster Abstracts early onset menopause in women with epileptic seizures in comparison to age matched controls. MeillOd: 5 women presenting a history of epilepsy and early menopause were studied along with a set of age matched controls. All data were acquired on a 3.0 Tesla Eclipse GE MRI scmmer using a transmit/receive head coil. A 512x512 T~ weighted coronal series was prescribed along the anterior/posterior commissure line to localize the base of the third ventricle and place the mxial MRS slices. A multi-slice 2D-CSI sequence from the NIH (J. Duyn, J.W. van der Veen) was used to prescribe 3 slices having a 32x32 grid size and a 7.5x7.5x15 mm voxel size. The PRESS based sequence used a sweep width of 1000 Hz, 256 points, a T R of 2300 ms and a TE of 280 ms for a scan time of 30 minutes. Spectra were transferred to an SGI Octane workstation for analysis using X s O s N M R software (IX. Mac, D.C. Shungu). Low-pass Hanmffng and Fermi k-space filters removed lffgh frequency noise components prior to FFT. A low-frequency Gaussian function was convolved with and subtracted from the data to remove the residual water signal. Data were zero-filled in time, to 512 points, and space to yield a 64×64 grid. Voxel shifting was performed prior to FFT in order to place a single CSI voxel on the center o f each side of the hypothalamus. A representative spectrum referenced N A A at 2.02 ppm and this spectrum was then used as a reference for susceptibility corrections applied to the entire grid. The correlation coefficient between each spectrum and that of the reference spectrum was minimized to eliminate spectral shifts between voxels. Peak areas were integrated between fixed ranges to obtain NAA, CRE and CHO values in ratio to RMS noise. Results: Metabolic ratios of NAA/CRE, N A A / C H O and CHO/CRE were calculated for the hypothalamus comparing values from the right side against the left as well as between the patient and control populations. In addition, ratios for the total hypothalamus were calculated and compared with normal grey matter within the same slice. N o significant variatimas in metabolic ratios between patient and control populations were observed. 0143 Epilepsy in rural Cameroon: the alarming prevalence rates in the Mbam valley Njamnshi, A r~, Dongmo, L ;, Sini, V ~, Echouffo, B;, Kamdem, P;, Pepouomi, M 2, Atchou, A 2. ~Central Hospital Yaounde-Neurology
Service, Cameroon; 2Faculty Of Medicine And Biomedical Sciences, University of Yaounde 1, Cameroon Background and Purpose: The epidemiology of epilepsy in Cameroon (Central Africa) has not been well described. A team from the Faculty of Medicine and Biomedical Sciences Yaounde, began a series of studies to determine the epidemiological, clinical, aetiological and therapeutic features of the condition and to propose strategies to fight against the disease in Cameroon, as a contribution to the worldwide fight against epilepsy. Patients and methods: Door-to-door surveys using the WHO/IENT criteria, have been carried out in 4 villages (total sample size of 8398 individuals) of the Mbam valley, situated about 135 kan north of Yaounde, to establish the descriptive epidemiology of epilepsy. Results: The prevalence rates of epilepsy in the four villages studied thus far have been 11.6%o for Yebekolo (sample studied* -- 2500), 27.0%o for Ossah (* - 2000), 49.0%0 for Bilomo (* -- 1898) and 60.5%o for Badissa (* - 2000). The general prevalence in the total sample studied (18398 individuals) was 35.4%o. The most affected age group was that from 10 to 29 years: 265 of 297 epileptics (89.2%). "rite sex ratio was 1.2 in favour o f males. Generalised tonic-clonic seizures were the most frequent seizure type: 223 (175.1%). Conclusions: These data obtained in the Mbam valley of Cameroon are alarming and call for an urgent concerted effort, both at the national and international levels to further investigate the aetiological and other factors involved. Tiffs would contribute towards building art effective healthcare system that would eventually control tiffs serious malady.