Pornchai Sathirapanya

Effect of switching hepatic enzyme-inducer antiepileptic drug to levetiracetam on bone mineral density, 25 hydroxyvitamin D, and parathyroid hormone in young adult patients with epilepsy

We sought to determine the effect of changing phenytoin therapy on bone mineral density (BMD) and 25‐hydroxyvitamin D in patients with epilepsy. Of the 90 patients, 54 patients had switched to levetiracetam, 19 patients had stopped, and 17 patients continued taking phenytoin. We proposed a 2‐year period to examine 25‐hydroxyvitamin D, parathyroid hormone, and BMD. The patients who switched or stopped phenytoin showed a significant increase in BMD of the lumbar spine and left femur, and in 25‐hydroxyvitamin D. In contrast, those who continued phenytoin had a significant decrease in BMD at both sites and in 25‐hydroxyvitamin D. Patients who were taken off phenytoin and those switching to levetiracetam did not show a significant difference in BMD, 25‐hydroxyvitamin D, parathyroid, or calcium at follow‐up. Compared with those who continued phenytoin, the BMD was significantly higher in patients switching to levetiracetam and those who stopped using phenytoin. Switching medications may be necessary in some cases to avoid low BMD.

Acute transverse myelitis associated with dengue viral infection.

Abstract Background: Acute transverse myelitis is a rare manifestation of dengue viral infection. Four cases have been previously reported in the literature. Objective: To report a case of a 61-year-old woman who developed acute transverse myelitis 6 days after the onset of a dengue viral infection. Findings: Magnetic resonance imaging of spinal cord showed hypersignal intensity on T2W at T9-T10. Laboratories studies revealed a high titer of hemagglutination inhibition of dengue virus. Treatment with intravenous pulse methylprednisolone and physiotherapy yielded a partial recovery, followed by complete resolution at 1 year postinfection. Conclusion: Acute transverse myelitis is a rare manifestation of dengue infection that can occur in either the peri-infectious or postinfectious phases.

Factors associated with quality of life in hemifacial spasm and blepharospasm during long-term treatment with botulinum toxin

PurposeThis study was undertaken to assess the impact of hemifacial spasm (HFS) and blepharospasm (BS) on quality of life (QOL) during long-term treatment with botulinum toxin injections.MethodsFifty-three patients with HFS and 32 patients with BS as well as two healthy age- and sex-matched control groups were included in the study. All participants independently completed the disease-specific questionnaire for QOL, the HFS-30, and the Thai Depression Inventory, and also provided a peak improvement score assessment.ResultsThe disease severity in both patient groups revealed mild functional impairment. The scores of HFS-30 in HFS patients (four of 8 subscales) and BS patients (3 of 8 subscales) were significantly higher than the control groups. In both HFS and BS, depression scores were positively correlated with the HFS-30 scores, while peak improvement and educational level were inversely correlated with the HFS-30 scores. Patients with BS were more affected in Mobility and Activities of Daily Living than HFS patients.ConclusionsBoth HFS and BS affect QOL both physically and mentally despite clinical improvement with botulinum toxin. Depression and peak improvement after injection were associated with the level of QOL.

Risk factors of recurrent seizure, co-morbidities, and mortality in new onset seizure in elderly

OBJECTIVE To determine the risk factors of seizure recurrence and the most common comorbidities in elderly patients with epilepsy. METHOD We did a retrospective study of 278 patients older than 65 years with first seizure. We evaluated electrolytes, blood glucose, urea and creatinine levels, and performed electrocardiography (ECG), and routine electroencephalogram (EEG) on all patients. We evaluated seizure recurrence and comorbidities at 2 years. RESULTS Univariate analysis found that significant (P<0.05) factors affecting seizure recurrence were etiology of seizure, EEG, and status epilepticus at first presentation. In multivariate regression analysis, etiology of seizure and EEG were significant statistical factors in seizure recurrence at 2 years follow up. Age, sex, duration of time between first seizure and diagnosis of seizure, seizure type, misdiagnosis of non-epileptic seizure, and use of antiepileptic drugs were not significant factors for predicting seizure recurrence. Depression and anxiety were the most common comorbidities in our study, followed by sleep-related disorders and stroke. There were no statistically significantly differences in comorbidities between patients who remained seizure free and patients who had recurrent seizure. CONCLUSION Most of the new onset seizures in our elderly patients were focal onset. Acute symptomatic etiology, remote symptomatic etiology, progressive symptomatic etiology and abnormal EEG features were powerful predictors of seizure recurrence, and mood disorder, sleep disorder and stroke were the common comorbidities.

The association between BsmI polymorphism and bone mineral density in young patients with epilepsy who are taking phenytoin

Purpose:  This study sought to determine the association between BsmI polymorphism and bone mineral density, 25‐hydroxyvitamin D, and parathyroid hormone levels in patients with epilepsy.

Characterization of glucose homeostasis and lipid profile in adult, seizure-free, epileptic patients in Asian population.

Background and purpose:  The most common prescribed antiepileptic drugs (AEDs), phenytoin and valproate, are potent enzyme inducers and inhibitors of the cytochrome P450 system, which interfere with lipid profile and glucose homeostasis. Studies on this topic have suffered from inadequate assessment of confounders and have rarely included glucose homeostasis and lipid profile as well as both enzyme inducers and inhibitors in the same study. We sought to determine whether these drugs had an effect on lipid profile and glucose homeostasis in Thai epileptic patients.

Clinical characteristics, etiology and long-term outcome of epilepsia partialis continua in adult patients in Thailand

OBJECTIVE Epilepsia partialis continua (EPC) is clinically defined as a syndrome of continuous focal jerking of a body part. EPC has various etiologies and outcomes depending on its cause. Most studies on EPC have been conducted in Western countries and no study on the long-term outcome in adult onset epilepsia partialis continua has been reported. The aim of this study was to analyze the clinical characteristics, etiology, and treatment outcome and measurement to identify conditions that are predictive of long-term excellent outcome following epilepsia partialis continua in Thailand. METHODS Our study was characterized by a retrospective systematic data collection between 2003 and 2010 that lead to the inclusion of a total of 75 patients, with epilepsia partialis continua at Songklanagarind Hospital, Thailand. All of the patients received brain CT scans or MRIs after diagnosis with EPC. Basic laboratory investigations including blood sugar, blood urea nitrogen, creatinine, electrolyte, calcium, liver function, and complete blood count tests were performed. Additionally, routine electroencephalography were performed and antiepileptic drugs were given to all patients. Therapeutic outcomes and the degree of seizure control after discharge were determined by the functional status and Seizure Frequency Scoring Systems, respectively. KEY FINDING All of our patients manifested as motor EPC. The mean duration of EPC was 6.2 days (range 1-30 days) and the most frequent distribution of EPC involved the face and arms (42.7%). Hyperglycemia was the most common cause of EPC (34 patients, 45.3%). Fifty-one patients had an excellent outcome and 24 patients had a non-excellent outcome. All of the patients with hyperglycemia had an excellent outcome and required no antiepileptics in the long term. Predictors of excellent outcome in the scoring system for seizure frequency were metabolic or hyperglycemia-induced EPC, monotherapy and duration of EPC. SIGNIFICANCE The characteristics of epilepsia partialis continua in this study were different from those of EPC in Western countries. Its most common cause was hyperglycemia and prognostic factors depended on etiology, number of AEDs, and duration of EPC.

Cerebral venous thrombosis: comparing characteristics of infective and non-infective aetiologies: a 12-year retrospective study

Background Most cases of cerebral venous thrombosis (CVT) have non-infective causes. Infective CVT, though less common, often results in a catastrophic outcome. The distinctive clinical characteristics of infection-associated CVT (IACVT) and non-infection-associated CVT (NIACVT) would facilitate early detection and proper management. Objective To compare the characteristics of IACVT and NIACVT. Methods All patients with CVT admitted to Songklanagarind Hospital between January 2002 and December 2013 with the ICD10 codes I636, I676, O225 and G08 were identified and recruited. We compared the clinical presentations, neuroimaging results and hospital outcomes for patients with IACVT and those with NIACVT. We analysed the differences using descriptive statistics. Additionally, for patients with IACVT, we described the primary sites of infection, associated CVT, host immune status and microbiological results. Results Twenty of the 83 patients with CVT (24.1%) had IACVT. Male gender (70.0% vs 34.9%) and pre-existing diabetes mellitus (35.0% vs 4.8%) were significantly more prevalent in the IACVT than the NIACVT group. Additionally, cavernous sinus thrombosis predominated in IACVT (80.0% vs 11.1%), whereas focal neurological syndrome was more common among patients with NIACVT (50.8% vs 15.0%). Paracranial infections, mostly sinusitis and orbital cellulitis, were common primary infections (80.0%) among patients with IACVT. Lastly, fungus was a devastating causative pathogen in IACVT—five of six patients with fungal infection had intracranial complications. Conclusions Cavernous sinus thrombosis is a distinctive clinical presentation of IACVT, whereas focal neurological syndrome is a hallmark feature of NIACVT. Paracranial fungal infections are highly virulent and frequently associated with intracranial complications.

Role of CYP2C9 polymorphism in phenytoin-related metabolic abnormalities and subclinical atherosclerosis in young adult epileptic patients

PURPOSE We investigated the influence of the CYP2C9 polymorphism on the lipid profile, insulin resistance, and subclinical atherosclerosis in young epileptic patients. METHODS We performed a cross-sectional study to evaluate the association between CYP2C9 polymorphism and lipid profile, glucose homeostasis, and subclinical atherosclerosis in young epileptic patients via the ankle brachial index. RESULTS The frequencies of CYP2C9*1 (CYP2C9 wild type gene) and CYP2C9*3 (CYP2C9 polymorphism gene) were 75% and 25%, respectively. The mean serum total triglyceride and LDL levels were significantly higher in the wild type gene subjects than in the CYP 2C9 polymorphism gene subjects. Also, the CYP 2C9 polymorphism had marginally significant lower mean serum HDL levels than the wild type gene subjects. No patients with CYP 2C9 polymorphism gene had elevated fasting blood sugar, and insulin resistance was found in only 10 of the 75 subjects. The mean ABI was statistically significantly lower in the wild type subjects than in the CYP2C9 polymorphism gene subjects. CONCLUSION Our study indicates that young epileptic patients with the CYP2C9 polymorphism gene have a low risk of subclinical atherosclerosis.

Adult tonic-clonic convulsive status epilepticus over the last 11 years in a resource-poor country: a tertiary referral centre study from southern Thailand

Status epilepticus is a common condition in patients admitted to hospital in resource-poor countries and reports indicate that aetiology, factors of poor outcome, and treatment strategies are variable. Todate, there is no report of a prospective study in Thai adults. Herein, we investigated the aetiology, clinical features, factors of predicted poor outcome, and treatment strategies in Thai adult patients who presented with convulsive status epilepticus. A total of 180 patients, whose ages ranged from 15 to 106 years, were included. Of these, 121 patients (67.2%) had acute symptomatic aetiology. The most common aetiology of status epilepticus was encephalitis (36.1%), followed by scarring of the cerebral hemisphere (15%). The median duration of status epilepticus before treatment was three hours. The rate of mortality in the study was 26.7%. Poor outcome was identified in 112 (62.2%) patients. For referral patients, all received only intravenous drugs before referral. The variables that correlated with poor outcome were aetiology and duration of status epilepticus. An approach to incorporate improved prevention of encephalitis, a more effective transportation system, and provision of the essential intravenous antiepileptic drugs would effectively increase the response to treatment.