Mayank A Patel

Abstract

Introduction: Despite the best possible pharmacotherapy, 30% of persons with epilepsy will remain drug resistant. Drug resistant Epilepsy (DRE) has many different presentations and causes; hence evaluation may help to understand and manage appropriately. Aim: To study a cohort of adult patients with refractory focal epilepsy, focusing on clinical semiology, risk factors, imaging and video EEG findings. Materials and Methods: This is a prospective observational study done in adult neurology department of tertiary care hospital, from 2013 to 2016. The primary inclusion criteria were patients with drug refractory focal seizure (as per ILAE definition 2010), with age more than 12 years. Detailed clinical data, long term EEG monitoring, MRI and minimum follow up of 6 months were collected. Results: Of 120 patients of DRE, 72% were in the age group of 12-30 yrs. Febrile seizure (26%) and head injury (17%) were the most significant antecedent history. Focal seizures with dyscognitive features were present in 87%. 16 patients had abnormal neurological examination. The most common radiological finding was mesial temporal sclerosis and gliosis. After complete evaluations, 30% of the patients were found to have pseudo-resistance. The evaluation led to modification of treatment in more than three-fourth of the patients. Summary: Early age of onset, history of febrile seizures, past history of head injury, focal dyscognitive type of seizures and structural lesion on imaging are common factors in patients with DRE. Pseudo- resistance due to wrong diagnosis and inadequate AEDs were responsible for one third of cases.   Keywords: Drug­resistant epilepsy (DRE), Focal dyscognitive seizures, mesial temporal sclerosis (MTS), Long­term EEG monitoring (LTEM), Pseudo­resistance

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Abstract

Background: Various neurological manifestations, including Acute Ishcemic stroke (AIS) has been described in association with SARS-CoV2 infection. Materials and Methods: In a government-regulated tertiary care center of COVID 19, we did a retrospective analysis and found 7 patients of AIS in 4 months duration. Results: All patients were more than 50 yrs of age, were in moderate to severe COVID19 category and had pre-existing stroke risk factors. Four out of 7 patients developed stroke 7-10 days after onset of COVID19 symptoms. (Range 2-17 days). 71.4 % (5/7) had large artery ischemic stroke; two had multiple arterial territory involvement and two developed hemorrhagic transformations. Every patient had elevated levels of one or more inflammatory and/or prothrombotic biomarkers. The prognosis was poor, in terms of high mortality and morbidity. Conclusion: Stroke mechanism in COVID19 may be multifaceted, varying from traditional atherosclerotic risk factors to large vessel thrombosis, embolism, prothrombotic state, coagulopathy, and/or vasculopathy. Key message: More than one mechanism may operate in AIS with Covid19 infection and similar observation studies in heterogeneous populations will guide us to understand the disease process better and its therapeutic strategies.   Keywords: Acute ischemic stroke, Covid19, Stroke mechanism, Prothrombotic state.

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