0113 The clinical and electrophysiologic characteristics of temporal lobe epilepsy with normal MRI

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Poster Abstracts

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Valproate is a broad spectrum AED effective in all forms of epilepsy and carbamazepine is recommended as first line treatment in partial seizures. Adverse effect profile of AED will play a crucial role in detemrirdng future prescribing practices. Recent studies have implicated valproate as an aetiological factor in the pathogenesis of polycystic ovary syndrome associated with sex hormone disturbances. Animal studies also have shown reproductive endocrine changes with valproate. Researchers have suggested that AED may be changing the metabolism of reproductive hormones resulting in alteration of circulating blood levels of these hormones and secondary effects on the feedback loop of tile hypothalamo-pituitary-gonadal (HPG) axis. Disturbances in HPG taxis hormones have been suggested to be playing a role in neuropsychiatric disorders. Objective of this study was to determine the pituitary gonadotrophin secretion in epileptic women treated with valproate and carbamazepine to compare with healthy age matched controls. Method: Serunl FSH and LH concentrations and LH/FSH were determined on the third day of the menstrual cycle in female epileptics of childbearing age on monotherapy with either carbamazepine (N -- 35) or valproate (N -- 30) for over two years and compared with age matched healthy controls. Conclusion: No statistically significant differences ill FSH, LH or LH/ FSH were found between groups, suggesting that neither valproate nor carbanlazepine has significant effect on pituitary gonadotroplffn secretion in epileptic women. 0109 Tile Ratio of Luteinizing]Follide stimulating HOrulones Among Teenage Gixls with Epilepsy

Kasradze S, Toidze O, Bidlashvili L. Centre for Control and Prevention

of Epilepsy, Tbilisi, Georgia Background: Alteration of hiteinizing/follide stimulating (LH/FSH) hormones ratio, one of tile marker of polycistic ovarian syndrome (PCOS) or hypothalamic hypogonadism (HH), is often found among epileptic women espedaly in cases with A E D started at puberty. These disturbances make some dificulties in seizure control. The aim was to investigate the level of LH/FSH ratio among teenage epileptic girls with and without AED. Methods: 112 consecutive epileptic women (mean age 16.3 ± 1.6 year) were investigated. 64 - had cryptogenic partial (CPE) and 48 idiopathic generalised (IGE) epilepsy. 65 were recieving treatment with any A E D (mean 2.7 -c 3.2 year) and 47 never take any AED. In all women levels of LH and FSH was measured on the 6-7t5 days of the menstrual cycle (97 cases) or randomly in cases with amenorhea (15 cases). Statistical analysis by SPSS (12). Results: Out of 112 girls LH/FSH ratio was lower lhen 0.5 in 31 (127.7°,5) cases; higher then 2.5 in 33 (129.5°,5) cases and normal (between 0.5-2.5) in 48 (42.9%) cases. Out of 65 girls with AED, low level o f ratio was revieled in 13 (20%) and among 47 untreated girls in 18 (38.3%) (iJ < 0.009). Higher level of ratio was revealed in 26 (78.8%) cases with A E D and in 7 (21.2"/o) without AED (p < 0.009). Distribution of low LH/FSH ratio was more often found among untreated girls with CPE (143.3"/o) then with IGE (35.3°,5) (p < 0.01) and on AED was equal among girls with CPE (120.2%) and IGE (19.49,';) (p < 0.01). Conclusion: Some anticonvulsants facilitate LH secretion and increase the risk of PCOS development; therefore tiffs could be positive effect for HH, so in teenage girls hormonal investigation is essential before treatnlent to choose AED.

0110 Topiramate: a monotherapy in Epilepsy Kathpal, j s SCoithram Hospital and Research Centre, India Aim: To assess the safety and efficacy of topiranlate in the treatment [as monotherapy] of patients with partial epilepsy with or without

secondary generalization and those with generalized tonic clonic seizure in day to day practice (newly diagnosed cases). MeillOdS: It is 6 month prospective open label study in which 50 patients o f all age groups were recruited according to tile inclusion and exclusion criteria and were started with low dose of topiranlate which was graduallyincreased. The most effective/best tolerated dose was then continued for 6 months of the observation period and the patient was asked to follow up every month. The efficacy was evaluated by comparing the monthly seizure frequency rate to that during historical 12 weeks period. All the patients were closely monitored for the side effects. Results: None of the patients had recurrence of seizure. The most common side effects reported were weight loss (10%) and paresthesias (15%). Contusion: Topiramate is safe and efficacious as a monotherapy in tile treatnlent of epilepsy. 0111 Pattern of Rel?actoty Epilepsy in an under developed area in India Khan, M . J l, Thacker, A.K1, M~sra, M ~, Mittal, M ~, Verma, A.M1, Mall, A . K ~. SB.R.D. Medical College, Gorakhpur, Uttar Pradesh, India Baekgrou.~d: The pattern of refi'actory epilepsy with regard to type of seizures and etiology was studied for one year in a referral neurology centre located in Eastern Uttar Pradesh, a thickly populated yet underdeveloped area of the most populous state o f India. Method: The patients were studied clinically and investigated in detail with a view to classify them according to ILAE classifications. The refi-actory epilepsy was defined as 2 or more disabling seizures per month for a period of 2 year or more despite supervised trial of six months each, twice with monotherapy and once with polytherapy. Eighty six patients were recruited, majority from age 16-30 years or younger (80.2%). Duration o f epilepsy in most was 2-15 years with onset below 15 years o f age. Results: Partial seizures were the commonest (59.3"/0) followed by generalized tonic clonic seizures (134.9"/o) only 2 (2.3°,5) had refractory absence seizures. Status epilepticus was noted in 9.3°,5. Positive family history (11.6%), brain trauma (8.1%) and past history of encephalitis (8.1%) were the main risk factors. EEG was abnormal in 46.5%. CI'/MRI abnormalities noted in 63.1% with healed/active cerebral cysticercas granuloma being the commonest (139.5°,5) followed by infarct (11.8"/o) and focal atrophy (111.8"/o), no patient had MTS. Localisation related epilepsy was commonest type of epilepsy (55.8"/0) followed by idiopathic generalized epilepsy (26.7%). Contusion: Obviously the therapeutic and preventive strategies for refractory epilepsy in this part of the world is different from the rest. 0112 Ralional Antiepilepfic Drug Use- Tile Comulon Pitfalls Kharbanda, P.S l, Prabhakar, S a, Lal, V a, Das, C P a, Khurana, D ~, Modi, M a. 1Postgraduate Institute of Medical Education and Research,

Chandigarh, lndia Backgrou,~d: A lot of epilepsy is managed outside the dedicated Epilepsy Clinics. The aim of this study was to analyze the treatment practices in these settings, to identify ally pitfalls and possible renledies. Method: We analyzed the prescription patterns of 80 consecutive cases of chronic epilepsy before they presented to the Refractory Epilepsy Clinic at our institute. Most of these patients had long standing epilepsy. Results: Out of a total of 80, 13 patients had received 2 drugs, 16 had received 3, 20 had received 4, 8 had received 5, 7 had received 6 and 16 had received 7 or more antiepileptic drugs, in various combinations. Ten patients were on 4 or more antiepileptic drugs at the time of presentation. Many patients had drug related side effects (155 of 80), commoner being cognitive impairment, gum hyperplasia, weight gain, drowsiness etc. Other conmlon practices noted were, use of suboptimal doses of nmltiple antiepileptic drugs, over treatment in form of

Poster Abstracts polytherapy or high maintenance doses, adding an additional drug without taking the first drug to the maximum tolerated dose and if taken there, not decreasing it even if it did not improve seizure control. The practice of alternative monotherapy was very uncommon. Conclusion: Most of these practices stem from either a lack of awareness or absence of clear-cat guidelines. What we probably need is an active educational campaign among professionals dealing with epilepsy at the primary healthcare level and clearer guidelines 0113 The Clinical and Electrophysiologic Characteristics of Temporal Lobe Epilepsy with Nomml MRI

Monday, November 7, 2005

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The 3/4 asserts that patient has received treatment from religious healers and visits to shrines. Among this population 33.5% described that treatment included readings from Koran, written down and amulets. Conclusion: Tiffs first study in Morocco and Arabic COmltries, revealed that southern Moroccans do not know enough about epilepsy and that cultural specific characteristics of understanding epilepsy lengthen the delay of diagnosis and treatment and harm the quality of care in patients with epilepsy. This confimlS the need of an awareness program in order to improve health education in general and to ameliorate the information status about epilepsy and strengthening the use of biomedical methods of treatment.

Kiln, S.E l, Andermann, F 2, Dubeau, F 2, Olivier, A ~. llnje University,

Pusan, Korea; 2MeGill University, Montreal Neurological Institute and Hospital, Montreal, Canada Background: To identify the clinical and electrophysiologic characteristics of temporal lobe epilepsy (TLE) with normal MRI. Methods: Twenty-six patients were diagnosed as TLE with normal MRI by stereotmxically implanted depth electrode EEG (SEEG) and quantitative MRL We divided them into anterior or diffuse temporal groups by interictal EEG, and into localized, hemispheric or nonlateralized onset by ictal scalp EEG, and into focal or regional onset by SEEG. The clinical and electrophysiologic characteristics were compared with those of 25 TLE with unilateral hippocampal atrophy (HA) on MRI. Four patients of TLE with unilateral HA also underwent SEEG. Results: Patients in the normal MRI group showed significantly higher frequency of secondarily generalization (1225 ± 235 versus 68 ± 48, p < 0.05), shorter duration (16 ± 10 yrs versus 25.9 ± 7.8 yrs, p < 0.001), and less favorable surgical outcome (50% versus 88%, p < 0.05) than patients in the unilateral HA group. Also, patient with normal MRI frequently showed diffuse temporal (150% versus 20%, p < 0.05) discharges on interictal EEG. The ictal seizure patterns o fpatients with normal MRI showed less localization to the one temporal lobe on scalp E E G (28% versus 65%, p < 0.001) and higher frequency of regional onset on SEEG (168% versus 8%, p < 0.001) than patients with unilateral HA. Conclusions: The characteristics of TLE with normal MRI compared with TLE with mrilateral HA are shorter duration of epilepsy, higher frequency of secondarily generalization, and less favorable surgical outcome, suggesting wider areas of temporal lobe involved compared to patients with unilateral HA. 0114 Knowledge and Traditional Practices Towards Epilepsy in South Morocco Kissani N, Arib S. Neurology department, CHU Mohammed VI

Marrakeeh, Morocco Background: Traditional practices are widely used in Moroccan epileptic patients. Our objective was to assess patients families knowledge and attitudes towards epilepsy and to identify sociocultural aspect and traditional practices towards epilepsy. Methods: A survey was conducted in neurology department of Marrakech; a region representative o f cultural patterns in south Morocco. It included 80 people; males and females; aged twenty years old and more, who were submitted to a standard 20 itenls questiomlaire. Results: Answers were recorded and tabulated in SPS S (version 10.0.5). The average age was 40.5 years (standard deviation -- 23.24). Female gender was more represented with 63.75% o f sample, and 45% were illiterate. Nearly 65<'/0 of respondents had heard or read about epilepsy. Whereas, more than half believe in the role of spirits (jinn), and bewitchinent in the development of their relatives illness.

0115 Clinical, Nemohnaging and Electrophysiological features of Ulalfornlations of Cortical Developulent in a large population with Epilepsy Kuchukhidze, G l, Embacher, N 1, Unterberger, 11, Dobesberger, j1, x~Valser, G 1, Luef, G 1, Ortler, M 2, Lukasser, H 1, Felber, S 3, Bauer, G 1, Trinka, E 1. 1University Clinic for Neurology', Epilepsy Unit, Irmsbruc]¢,

Austria; 2Universi(v Clinic for Neurosurgery, Innsbruc]¢, Austria; 3University Clinic for Radiology, Snnsbruc]¢, Austria Background: Malformations of Cortical Development (MCD) represent heterogenous disorders of neuronal proliferation, migration and organization commonly associated with intractable epilepsy. The study aim was to evaluate clinical, neuroimaging and electrophysiological features of MCD in a large epilepsy out-patient clinic. Method: All patients with MRI verified MCD underwent clinical, neuroimaging and electrophysiological assessment. Results: We reviewed 83 consecutive patients, [39 women (47%) and 44 men (153%); median age was 38 years (range 18-72)] with the following MCD: malformations of neuronal proliferation 19 (23%), malformations o f neuronal migration 19 (123<'/o),malformations of neuronal organization 28 (1349,';) and combined malformations 17 (20%). Reviewed subjects had generalized (GE) 9 (119,';) and partial (PE) 7:1 (1899,';) epilepsies. PE included extra-temporal [ETE (151)] and temporal lobe [TLE (23)] epilepsies. On interictal EEG 44 (53°,5) had spike-waves or sharp waves, 86°,5 of which were localised and 14<'/owere generalised. 1119 cases spiking was rhytlnnic. Localised slow activity was seen in 18 (122°,5) and generalised or diffuse slowing - in 13 (169,';). Only 7 (89,';) patients had normal interictal EEG. In 13 cases EEG-Video monitoring was performed showing ictal fast or slow recruiting activity in 10 cases and rhythmic localised and generalised spiking in 3 cases. Conclusion: The largest MCD group in reviewed subjects was malformations of neuronal organization (34<'/0). The majority of patients had PE (189%), o f which the largest group was ETE (1699,';). On EEG more than a half of total number of patients had interictal spiking (153%). 0116 Juvenile Myoclonic Epilepsy and its pattern in Kanpur, India Kumar, N l, Agarwal ,A1, Kumar, A1, Narayan, p1. 1GSVM Kanpur,

India Background: Juvenile Myoclonic Epilepsy (JME) is a type of idiopathic generalized epilepsy (IGE) with variable presentations and specific treatment for a long time. We tried to study its features along with the course of illness. Method: Neurology unit at GSVM Kanpur caters to about 5 million population. It was established in 1989 and about 10000 cases of neurology are seen every year. During the last 6 years, around 2800 cases of epilepsy were registered. JME was diagnosed in 282 cases on the basis of clinical features and E E G findings. Other factors like drug response, family history and tendency to recur were also studied.