M. C. Maheshwari

Usefulness of short-term video EEG recording with saline induction in pseudoseizures.

Objectives ‐ To study the usefulness of short‐term recording of video electroencephalography (VEEG) as an outpatient procedure with placebo induction (PLIN) and intravenous saline in cases of pseudoseizures (Psz). Material and methods ‐ Fifty cases of suspected Psz were enrolled. They were divided into 2 groups: Group 1 consisted of patients with frank Psz, Group 2 those where diagnosis was uncertain. VEEG recording was done and 10 ml of saline used for placebo‐induction. Results ‐ Of 50 patients, 24 (48%) were in Group 1 and 26 (52%) in Group 2. Fifteen (30%) had a spontaneous event during VEEG and 33% had an event only on PLIN. The diagnosis was confirmed in 60%. In 24% of patients anti‐epileptic drugs were discontinued. Conclusion ‐ Short‐term monitoring with VEEG using PLIN is a useful initial screening procedure and in patients where it is inconclusive, long term recordings may be done.

Occurrence of only myoclonic jerks in juvenile myoclonic epilepsy

Objectives ‐ The clinical data on individuals who were diagnosed to have juvenile myoclonic epilepsy (JME) on the basis of myoclonic jerks alone has been analysed. The points in favour and against individuals with only myoclonic jerks being classified as “affected” for research on JME are discussed.

Appearance of tuberculoma during the course of TB meningitis

SummaryA patient with tuberculous meningitis is described, who developed brainstem tuberculoma after 7 months of adequate drug therapy and while improving satisfactorily. The possible factors resulting in the development of tuberculoma are discussed. The tuberculoma responded to the medical therapy. Tuberculoma should be looked for if the condition of the patient worsens or if the patient develops new neurological signs during the course of TB meningitis.

Incidence of photosensitive epilepsy in unselected Indian epileptic population

The recognition of photosensitivity depends upon the finding of an abnormal EEG response to intermittent photic stimulation (IPS). Photosensitive epilepsy being the most common form of reflex epilepsy, has been studied most extensively and is reported to account for 5–10% of the epileptic population in general. One thousand unselected epileptics hailing from different parts of Northern India were screened for photosensitivity, both clinically and on a standard protocol of IPS‐provoked EEG recordings. Six patients (mean age 14.5 ± 3.56 yr) were found to be photosensitive: 4 had generalized, 1 had complex partial and 1 mixed seizures; 3 had history of seizures provoked by visual stimuli. The baseline EEG in 4 patients showed generalized and 2 partial, with secondary generalized, epileptiform discharges. On IPS, similar EEG findings were obtained with a wide range of stimulus frequency (6–60 cycles/s). There is a low incidence of photosensitivity in our epileptic population, for which we believe, genetic factors are responsible.

Spontaneous intraventricular haemorrhage

SummaryTwenty-one patients with spontaneous intraventricular haemorrhage (IVH) were reviewed with particular reference to the clinical outcome. Based on clinical and computed tomography (CT) findings, as well as possible mechanisms governing the formation of IVH, we were able to identify two separate groups: (1) patients with haemorrhage into ventricles without clinical or CT evidence of a lesion in adjacent brain parenchyma and (ii) patients with IVH occurring as a result of erosion of the ventricular wall by either a juxtaventricular small haematoma shown by CT and/or IVH with focal neurological deficit. Out of 12 patients in the first group, 8 survived and resumed their previous activities; in the second group (i.e. patients with clinical and/or CT evidence of adjacent intraparenchymal bleeding only three patients survived, two with considerable handicap. The overall prognosis, however, was significantly better in patients with IVH of unknown cause. Altered sensorium as an initial presentation was associated with a grave prognosis, irrespective of the cause of IVH. The outcome was not affected by the age of patient or the amount of blood within the ventricles. Our data suggest a favourable outcome in a relatively large percentage of patients with spontaneous IVH, if there is no clinical or CT evidence of concomitant parenchymal bleeding. Hence we question the notion that there is a grave prognosis in all kinds of IVH.

Juvenile myoclonic epilepsy : disease expression among Indian families

Objectives ‐ Juvenile myoclonic epilepsy (JME) is a common, age related, idiopathic generalized epileptic syndrome. We aimed to define the expression of JME in Indian probands and study the occurrence of seizures/ epileptic syndromes in their family members. Methods ‐ We studied 225 JME probands with a uniform protocol, recording the type and frequency of seizures, precipitating factors, EEG data, and family history. Detailed family pedigrees were drawn to include all the 1st‐ and 2nd‐degree relatives of probands. The seizures/epileptic syndromes in relatives examined were classified in a uniform way. Results ‐ The clinical and EEG characteristics of 225 JME probands from India were similar to those reported in probands from different ethnic backgrounds. The incidence of febrile convulsions in probands with JME was similar to that of the general population but was much lower (0.2%) among their relatives. A positive family history of seizures among 1st‐ or 2nd‐degree relatives was noted in 79 of 225 (35%) probands. The risk of relatives being affected as well as their risk of expressing a type of idiopathic generalized epilepsy (IGE) varied as a function of the degree of relation with the probands. Conclusions ‐ The clinical expression of JME among probands from India is fairly similar to that reported in probands of different ethnic backgrounds. The risk of relatives being affected as well as their risk of expressing a type of IGE (including JME) varies as a function of the degree of relation with the probands. The reduced occurrence of febrile convulsions among the relatives of JME probands probably represents an ascertainment bias. A much larger database of this type should be helpful in understanding the interactions of different genes that are believed to be responsible for some of the inherited human epileptic syndromes like JME and other IGEs.

Left thalamic hypertensive haemorrhage presenting as transient global amnesia

ABSTRACT— A case is described which presented as transient global amnesia (TGA) due to a critically placed intracerebral hypertensive haematoma in the left thalamic region, with epileptic discharges arising from the same area. It is proposed that intracerebral haematomas may occasionally present as a clinically well‐defined neurological syndrome. The deficit in such cases is probably not due to the underlying direct tissue damage but secondary to indirect pressure or ischaemic insults.

Forceps delivery as a risk factor in epilepsy: a comparative prospective cohort survey

Three‐hundred and eighty‐one children born with forceps delivery and 372 with normal delivery were followed up for 4‐7 years. More children in the forceps group developed seizures than in normal group, i.e. 22:10. This was statistically significant (P < 0.05). A prolonged follow‐up is necessary for further observations.

Gabapentin in refractory partial epilepsy — a trial in India

Gabapentin (GBP) has been shown to be effective an add‐on drug for the treatment of refractory partial epilepsy. We undertook an open clinical trial to test its efficacy for the first time in India. Twenty‐six patients with refractory partial seizures (> 4 per month) were given GBP in a titrated dose and the seizure frequency was noted for 3 months. The mean reduction in seizures was significant: 15.87 (SD = 4.5) vs 5.80 (SD = 10.25). The mean percentage change (PCH) from the baseline was ‐ 36. Twenty‐one of 26 (80%) patients had a reduction in the number of seizures, and 13/26 (50%) were identified as responders (> 50% reduction in seizures). The responders were significantly younger than the nonresponders. Adverse events were mild and noted in 46% patients. Although the trial has its limitations, this is probably the first trial of GBP in a developing country.

Hemiplegia in posterior cerebral artery strokes

Hemiplegia is an unusual presenting feature of posterior circulation strokes. We report five cases who presented with hemiplegia and in whom CT scans revealed evidence of infarcts in posterior cerebral artery territory.