ECT in an Adolescent With Schizophrenia and Seizures: Case Report

Electroconvulsive therapy (ECT) has been recognized as an effective treatment option in catatonia, and for prolonged or severe affective episodes and schizophrenia. Response rates vary from 40 to 80% in adolescents. The procedure is safe if the required precautions are undertaken. Nonetheless, ECT remains a serious clinical challenge in patients with comorbid seizures. We present a case study of a 17-year-old female student suffering from schizophrenia who was scheduled for ECT due to prior treatment inefficacy. Seizures had occurred a few days before the first ECT session. Nevertheless, the patient received the ECT course, combined with clozapine at 125 mg/day, after neurological diagnosis and treatment modification because the illness became life-threatening. The patient's clinical outcome was satisfactory without any seriously adverse events and further improvements were observed in the mental state following long-term psychosocial treatment at our inpatient unit. A few months later, epilepsy was however diagnosed with probably coexistence of partial seizures and seizure-like events without EEG correlate. Administering ECT in patients with seizure comorbidity was also investigated based on previous research. Data on this is, however, extremely scarce and to the best of our knowledge, the safety and efficacy of using ECT in adolescents with schizophrenia and seizures has yet not to any great extent been discussed in the literature.

Cardiac Sodium Channel Blockade Due to Antiepileptic Drug Combination

Drugs that inhibit voltage-dependent sodium channels are commonly used to treat epilepsy. Old and novel antiepileptic drugs are used either as monotherapy or in combination to control epilepsy. For a long time, carbamazepine has been used as the first choice for the treatment of simple and complex partial seizures. In the USA, lacosamide was approved in October 2008 as an adjunctive treatment for partial-onset seizures. We describe the effect of two sodium channel blockers on the heart of a patient with epilepsy.

Quinine in the Treatment of Malignant Migrating Partial Seizures in Infancy: A Case Report

The syndrome of malignant migrating partial seizures in infancy was first described by Coppola and colleagues in 1995. The International League Against Epilepsy defines this form of epilepsy as a seizure onset in the first 6 months of life, occurrence of almost continuous migrating polymorphous focal seizures, combined with multifocal ictal EEG discharges, and progressive deterioration of psychomotor development. Most cases are pharmacoresistant and have poor outcomes. A lot of publications described the trial of several medications such as Stiripentol, Rufinamide, Cannabidiol, and finally Ketogenic diet, to control the refractory devastating seizures. We describe a 13-month-old girl with malignant migrating partial seizures in infancy who was started on Quinine for the control of her refractory seizures after the trial of multiple antiepileptic medications that failed to control her seizures, including Clonazepam, Carbamazepine, Phenobarbitone, Phyntion, Midazolam, Valproate, Perampanel & Ketogenic diet, all were tried by different combination at different times. Finally, as malignant migrating partial seizures in infancy are sometimes linked to K channelopathy, a trial of Quinine was given in a dose of 30mg/kg/d. Patients showed an excellent response with control of clinical & electrographic seizures. Now she is seizure-free for five months and undergoing physiotherapy. She started rolling over but doesn't have much improvement in motor milestones, is not following or cooing, and is unable to say clear words. Keywords: MMPSI – malignant migrating partial seizures in infancy- Quinine – Intractable epilepsy- CPLANE-1 gene defect

A Review on Analytical Method for Determination of Lamotrigine in Bulk and Pharmaceutical Dosage Form

Lamotrigine is an anticonvulsant drug used in the treatment of epilepsy & bipolar disorder/major affective disorder (manic depression). Lamotrigine is and antiepileptic drug of phenyltriazine class. For epilepsy it is used to treat the partial seizures, primary and secondary tonic-clonic seizures, and seizures associated with the Lennox-Gastuat syndrome and are chemically unrelated to the other anticonvulsants. Lamotrigine is a phenyltriazine that has comparatively few side-effects and it does not requires blood monitoring/observance in monotherapy. It additionally acts as a mood stabilizer. Common side-effects of lamotrigine include, nausea, sleepiness, headache, vomiting, trouble/bother with co-ordination and rash. Serious side-effects include in, lack of red blood cells, accumulated in risk of suicide, Stevens-Johnson syndrome and allergy. It issues that use of lamotrigine throughout pregnancy or breastfeeding it’s going to lead/result in harm/damage.

Etiological classification of seizures in pediatric age group (6-12years) – MRI study

Background: A seizure is an occurrence of signs or symptoms due to abnormal excessive orsynchronous neuronal activity in the brain. The present study aims to study the etiological factorsand clinical profile for new-onset seizures in children aged 6-12 years and to determine thefrequency of Magnetic resonance imaging (MRI) abnormalities in the pediatrics age group with new-onset unprovoked seizure and those with inadequately investigated longstanding epilepsy andclassify the etiology based on the MRI findings. Methods: A prospective study involving a total of 50patients was recruited aged between 6 to 12 years. All of them underwent neuro-imaging with MRI.Uncooperative patients were imaged following sedation and monitoring by the anesthetist. Allchildren aged 6-12 years who presented with new-onset seizures were included. All MR images wereobtained at a 3-mm section thickness except magnetization-prepared rapid gradient-echo images,which are obtained at a 1.8-mm section thickness. Results: Of the 50 patients 28 presented withgeneralized tonic-clonic seizures, 12 with simple partial seizures, 10 with complex partial seizures.Generalized seizures were a more common presentation than partial seizures in children 6-12 yearsof age. Conclusion: With the positivity of the MRI in the new-onset seizure in children between 6-12 years in our study gives an important aspect of the essential factor of imaging in pediatric new-onset seizures.

Clinical Efficacy and Safety Profile of Anterior Thalamic Stimulation for Intractable Epilepsy

Introduction Deep brain stimulation of the anterior nucleus of the thalamus (ANT DBS) is a neuromodulation therapy for patients with refractory partial seizures. The ANT is the structure of a limbic system with abundant neuronal connections to temporal and frontal brain regions that participate in seizure propagation circuitry. State of the Art We have performed a literature search regarding the clinical efficacy of ANT DBS. We discuss the surgical technique of the implantation of DBS electrodes with special attention paid to the targeting methods of the ANT. Moreover, we present in detail the clinical efficacy of ANT DBS, with a special emphasis on the stimulation parameters, a stimulation mode, and polarity. We also report all adverse events and present the current limitations of ANT DBS. Clinical Implications In general, the safety profile of DBS in intractable epilepsy patients is good, with a low rate of surgery, hardware-related, and stimulation-induced adverse events. No significant cognitive declines or worsening of depressive symptoms was noted. At long-term follow-up, the quality-of-life scores have improved. The limitations of ANT DBS studies include a limited number of patients treated and mostly open-label designs with only one double-blind, randomized multicenter trial. Most studies do not report the etiology of intractable epilepsy or they include nonhomogeneous groups of patients affected by intractable epilepsy. There are no guidelines for setting initial stimulation parameters. All the variables mentioned may have a profound impact on the final outcome. Conclusions ANT DBS appears to be a safe and efficacious treatment, particularly in patients with refractory partial seizures (three-quarters of patients gained at least 50% seizure reduction after 5 years). ANT DBS reduces most effectively the seizures originating in the temporal and frontal lobes. The published results of ANT DBS highlight promise and hope for patients with intractable epilepsy.

A Study On Clinical Profile And Semiology In Complex Partial Seizures And Its Radiological Correlation

Background: Epilepsy is the second most common and frequently encountered neurological disorder which poses huge threat to known healthcare systems worldwide also causing financial, socio economic burden to the community. Complex Partial Seizures are a form of focal epileptic seizures that may impair consciousness. Aim and objectives: Our motivation for the study was to understand the extent of patients with complex partial seizures associated with medial temporal lobe sclerosis. Materials and methods: We performed a cross sectional study about patients with complex partial seizures in Thanjavur medical college and hospital about their clinical profile and neuro-radiological correlation. Statistical analysis and results: Through our multimodal study with EEG, MRI on N=118 (female / male, age range, Most common age group- 10-20 years, mean age of 23 years, SD- 14 years, 66% males), we observed that atypical febrile seizures and fever provoked seizures has more association (18%) to complex partial seizures and to medial temporal lobe sclerosis in comparison to 12% in an earlier study. Conclusion: We believe this study summarizes the complex partial seizure features, origin, and their link to Medial Temporal lobe Sclerosis in our subject pool from Thajavur, India. Limitation: There are some limitations to our study, especially with no video EEG monitoring and no invasive EEG recording. We aim to improve them in our future studies.

Design and validation of the Gingkolide estimation using RP-HPLC analytical tool

Gingkolide is an antiseizure medicine used as an adjuvant of partial seizures and GAD to relieve neuropathic pain. It binds to the very high affinity alpha delta site in the CNS. Although the drug's mechanism remains unclear, in genetically engineered mice and other anticonvulsive models, findings showed that it binds to alpha receptors. A rapid rise in the number of drugs added to each class of drugs has been noted. Whether in a single or multi-drug delivery form, these medications are developed into newer formulations. These newest formulations put on the market need a new investigation to estimate the medication in the formulations. In the scientific literature, the current analytical procedures for such drugs are available, but not all approaches are stable and economical to use. Few other techniques are often time-consuming. The goal of this work was to develop an RP-HPLC analytical tool for Gingkolide estimation. The drug's RP-PLC study meets the drug's optimum integrity, suitability, regeneration. The drug's LOQ and LOD were reached with elevated sensitivity. Overall, the results show that the recommended analytical approach in the formulation should be used to evaluate the drug. For regular study of the medication in its dosage form, this approach may be recommended.