Emotions, Behavior & Learning in Children with Epilepsy
Mahmoud I Abeidah
Hamad Medical Corporation, Doha, Qatar
Purpose: Highlight the challenges we face in looking after children with epilepsy and developmental disorder and/or learning disabilities
Method: In this presentation we will be looking into the complexities of these relationships between epilepsy, behavior and other related issues including epilepsy, autism and ADHD connection. With the aid of videos and other materials we will demonstrate that managing epilepsy in these children can be a challenging yet also a rewarding experience
Results: We will discuss the difficulties we face as clinicians when we look after people with epilepsy and comorbidity. We will share with you our personal practice and experience in providing specialist service for children and young people with epilepsy and developmental disabilities at the secondary and tertiary levels.
Conclusion: Epilepsy is more common in people with developmental/ learning disabilities than in the general population. Likewise many children with epilepsy are likely to present with spectrum of psychosocial, behavioral or emotional problems and the more severe the epilepsy the more likely it is that a person will also have these disorders
PREVALENCE OF PSYCHIATRIC DISORDERS AMONG CHILDREN AND ADOLESCENTS WITH ACTIVE EPILEPSY IN RURAL SOUTHWESTERN UGANDA
Joseph Kirabira1, Alice Lam2, Godfrey Zari Rukundo1
1Mbarara University of Science and Technology (MUST), Mbarara, Uganda; 2Harvard University, Boston, USA
Purpose: To determine the prevalence of emotional, behavioral and developmental disorders among children and adolescents with active epilepsy in southwestern Uganda.
Method: We conducted a cross sectional study among children and adolescents aged 5 to 18 years with active epilepsy at Mbarara Regional Referral Hospital psychiatry department and its three mental health community outreach clinics. Trained research assistants collected data using a piloted electronic questionnaire. Psychiatric disorders were assessed using the parent version of Child and Adolescent Symptom Inventory 5 (CASI-5), which is a Diagnostic and Statistical Manual of Mental Disorders version 5 based rating scale
Results: 161 participants were assessed and the mean age was 12.6±4.4. Emotional disorders were the most prevalent; 42.2% (95%CI 34.5-50.3), followed by developmental disorders; 33.5% (95%CI 26.3-41.4) and behavioral disorders; 19.9% (95%CI 14.0-26.9). The most common behavioral disorders included oppositional defiant disorder, conduct disorder hair pulling and skin picking. Developmental disorders including autism spectrum disorder, Attention Deficit Hyperactivity Disorder, tics and elimination disorders were associated with young age (adjusted odds ratio (aOR)=0.9, p=0.039), use of other chronic medication (aOR=3.2, p=0.029) and early age at seizure onset (aOR=0.9, p=0.004). Emotional disorders, which included selective mutism, anxiety disorders, mood disorders and binge eating, were mainly associated with use of other chronic medication (aOR= 4.1, p=0.043), whereas having family history of epilepsy was protective (aOR= 0.36, p=0.019).
Conclusion: Psychiatric disorders are highly prevalent among children and adolescents living with epilepsy in southwestern Uganda. Therefore, there is need to integrate routine screening and management of these disorders into epilepsy clinical care.
Acknowledgement
I would like to acknowledge MURTI under NIH grant number D43TW010128 for funding this study. I also appreciate Prof. Kenneth D. Gadow for providing us with the CASI 5 rating scale for use during this study
Seizure outcome and prognostic factors for surgical management of hypothalamic hamartomas treated by stereotactic endoscopic disconnective procedure
Sarah Ferrand Sorbets, Martine Fohlen, Nathalie Dorison, Mathilde Chipaux, Olivier Bekaert, Christine Bulteau, Olivier Delalande, Georg Dorfmuller
Rothschild Foundation, Paris, France
Purpose: Hypothalamic hamartomas (HH) are rare benign lesions frequently associated with gelastic seizures early in life. Epilepsy can progress to multiple seizure types with cognitive and behavioral disturbance, leading in some cases to epileptic encephalopathy.
Method: We report a retrospective series of 136 adult patients and children treated in our institution between 1998 and 2016. The results in terms of epidemiology, morbidity and epileptic outcomes were analyzed
Results: According to Delalande’s classification, 4 patients had a type I hamartoma, 82 a type II, 37 a type III and 13 had a type IV. Trans-ventricular stereotactic endoscopic disconnection was performed in 92% of the 231 procedures. Mean age at seizure onset was 23 months, and mean age at surgery was 11.1 years. Mental retardation was present in 58.8% at the time of surgery. Patients required more than one surgical procedure in 48.5%. For all HH types, 77.5% of patients had an excellent outcome (Engel 1 or 2) and 83% in patients with type II hamartoma, with a mean follow-up of 5.4 years. The overall permanent complication rate was 7.7%. A short time from seizure onset to surgery was a significant prognostic factor for a good outcome (p comprised between 0.009 to 0.04 according to the delay). Patients with a cognitive delay at the time of surgery have a worse outcome (p=0.04).
Conclusion: Endoscopic disconnection is a safe and efficacious surgical option with good seizure outcome and immediate treatment results. An early surgical treatment allows avoiding active epilepsy during critical cortical maturation windows.
Changes in vital signs during epileptic and psychogenic non-epileptic attacks
Reda Badry
Asyut University Hospital, Asyut, Egypt
Purpose: To compare ictal vital signs (iVS) during epileptic seizures (ES) and psychogenic non-epileptic attacks (PNEA).
Method: 94 adults had video-EEG monitoring for variable durations. Heart rate (HR), oxygen saturation (SaO2), respiratory rate (RR), systolic (SBP) and diastolic blood pressure (DBP) were obtained at baseline and during the attack. Detailed semiology of each ES and PNEA was also assessed.
Results: The 49 patients with ES and 45 patients with PNEA had similar baseline vital signs. ES yielded a higher ictal HR (p = 0.003) and lower SaO2 (p = 0.04) than PNEA. RR and SBP of patients with PNEA were higher than those of patients with ES (p = 0.02, P= 0.04 respectively). Diastolic BP did not differ between groups (p = Not Significant). For ES, the change in ictal HR was inversely correlated with a ictal SaO2 (p = 0.003). In PNEA, ictal HR is directly correlated with systolic BP (p = <0.005).
Conclusion: The inverse relationship between ictal HR and ictal SaO2 in ES suggests the intense cardio-respiratory dysfunction during ES. The significantly elevated ictal HR, RR and ictal systolic BP during PNEA demonstrates risk of those attacks if not stopped.
Pediatric Hemispherotomy following perinatal ischemic stroke: about 63 cases.
Nathalie Dorison, Sarah Ferrand-Sorbets, Martine Fohlen, Delphine Taussig, Mathilde Chipaux, Olivier Delalande, Christine Bulteau, Georg Dorfmuller
Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
Purpose: Pediatric ischemic stroke accounts for 20% of the indications of hemispherotomy in the context of severe hemispheric epilepsy with hemiparesis and homonymous lateral hemianopia. Following perinatal ischemic stroke, 40% of children have epilepsy which becomes drug-resistant in 25% of cases. Spasms and Continuous Spikes and Waves during Sleep (CSWS) are common and sometimes isolated. In some intractable epilepsy we propose hemispherotomy.
Method: In our series of 289 hemispherotomies (1990-2016), 63 patients have vascular lesions. All met the usual indications for hemispherotomy; 3 patients had isolated spasms. We noted a predominance for males (40/23) and left hemispherotomies (40/25); 2 of them needed a second disconnection. The average age at surgery was 10 y/o (range: 1.1-36.5 y/o) with a mean post- operative follow-up of 5 years.
Results: All epilepsies improved on: 77% Engel 1, 14% Engel 2 and 8% Engel 3. We noted a consistent recovery in walking ability. The paresis of the upper limb may be aggravated. Cognitive progress was better compered to or other indications than ischemic stroke, and when performed at young age. The 3 patients with isolated spasms, all operated under the age of 3 years, reached an excellent outcome (Engel 1 or 2) with a good cognitive recovery. Non-infectious postoperative fever occurred in 78%. The commonest post- operative complications were subdural hygroma and hydrocephalus (19%), with the need of shunt placement in 11%.
Conclusion: Compared with other indications for hemispherotomy, patients with a vascular aetiology have significantly less residual epilepsy, complications and a better cognitive progression, especially when surgery is performed at a younger age. Early hemispherotomy in drug-resistant epilepsy related to a perinatal stroke may cure the seizures even if the patient has infantile Spasm or (CSWS) during sleep as the only seizure type and might prevent further mental retardation in some children.
BASIC SCIENCE
p01 EPILEPSY IN GUINEA: ABOUT 257 PATIENTS SEEN IN FREE CONSULTATION
CISSE Fodé Abass1, FOKSOUNA Sakadi2, AMINOU TASSIOU Nana Rahamatou3, BALDE Amadou Talibé4, BAH Aissatou Kenda1, NITCHEU WOGA Arcel Steven5, FARRAH Jasmine Mateen6, CISSE Amara1
1Ignace Deen Teaching Hospital, Conakry, Guinea; 2Ibn Sina Hospital Center, Rabat, Morocco; 3Hospital Center South of Paris, France; 4University Hospital Hautepierre, Strasbourg, France; 5Pointe à Pitre University Hospital Center, Guadeloupe, France; 6Massachusetts General Hospital, Boston, United States
Purpose: Purpose to characterize people with epilepsy (PWE) presenting to a free neurology consultation and antiepileptic drug (AED) service in the Republic of Guinea.
Method: Guinea is a low-income country in West Africa that recently experienced an Ebola Virus Disease epidemic. Community-dwelling PWE were seen at a public referral hospital in Conakry, the capital city. During two visits in 2017, an African-U.S. team performed structured interviews and electroencephalograms and provided AEDs.
Results: Results Of 257 participants (143 children, 122 female), 25% had untreated epilepsy and 75% met our criteria for poorly controlled epilepsy. 59% had >100 lifetime seizures and 58% reported a history consistent with status epilepticus. 38 school-aged children were not in school and 26 adults were unemployed. 115 were not currently taking an AED, including 50 participants who had previously taken an AED and stopped. Commonly cited reasons for AED discontinuation were perceived side effects, unaffordability, and unavailability of AEDs. Traditional medicine use was more frequent among children versus adults (92/143 vs. 60/114, p=0.048). 57 participants had head injuries, 29 had burns, and 18 had fractures. In a multivariable regression analysis, >100 lifetime seizure count was strongly associated with seizure-related injury (p<0.001). Burns were more likely to occur among females (p=0.02).
Conclusion: There is an urgent need to improve the standard of care for PWE in Guinea. Several missed opportunities were identified, including low use of AEDs and high use of traditional medicines, particularly in children. Targeted programs should be developed to prevent unintentional injury and improve seizure control.
p02 Potassium chloride cotransporter-2 is an important facilitator for epileptogenesis
Yun Wang
Institutes of Brain Science, Fudan University, Shanghai, China
Purpose: GABAA receptor-mediated inhibition depends on the maintenance of low level intracellular [Cl−] concentration, which in adult depends on neuron specific K+-Cl- cotransporter-2 (KCC2). Previous studies have shown that KCC2 was downregulated in both epileptic patients and various epileptic animal models. However, the temporal relationship between KCC2 downregulation and epileptogenesis is still unclear. In this study, we explored the relationship and the influence of KCC2 downregulation on epileptogenesis.
Methods: Both pilocarpine and cyclothezide induced in vivo and in vitro epilepsy models were used in this study. Patch clamp electrophysiology, western blotting and immunohistochemistry were used to detect the structure and functional change of hippocampal neurons during epileptogenesis.
Method: Both pilocarpine and cyclothezide induced in vivo and in vitro epilepsy models were used in this study. Patch clamp electrophysiology, western blotting and immunohistochemistry were used to detect the structure and functional change of hippocampal neurons during epileptogenesis.
Results: Significant downregulation of plasma membrane KCC2 was directly associated with severe (Racine Score III and above) behavioral seizures in vivo, and interestingly occurred before the epileptiform bursting activities. Suppression of membrane KCC2 expression by shRNAKCC2 both in vitro and in vivo, induced spontaneous epileptiform bursting activities and seizure behavior. Furthermore, either overexpression of KCC2 using KCC2 plasmid or blockade of KCC2 down regulation with Frusemide, a KCC2 inhibitor, effectively enhanced the resistance to convulsant stimulation induced epileptiform activities. In addition, blockade of KCC2 down regulation both in acute and silent period prevented the occurrence of chronic seizure.
Conclusion: Our findings demonstrated that altered expression of KCC2 is not the consequence, but likely is the contributing factor for both induction and progression of chronic seizure.
CLINICAL NEUROPHYSIOLOGY
p03 Malformations of cortical development and epilepsy
Naima Sghaier, Rafik Machraoui, Hbib Sfar, Samia Younes
University Hospital, Mahdia, Mahdia, Tunisia
Purpose: A review of the literature allowed us to describe the electro-clinical aspects and the EEG results for each type of malformation according to the location of the MCD in the MRI and to discuss the evolution and therapeutic alternatives to these MCDs
Method: We carried out a retrospective and descriptive study of a series of 6 patients. The patients consulted in the Department of Neurology of the Taher Sfar hospital in Mahdia over a period of 5 years between 2008 and 2013. Two inclusion criteria were used in our study: cortical developmental malformation on MRI and epileptic seizures as a main clinical manifestation.
Results: According to the classification of Barkovich et al. (2005), our patients are distributed as follows: Three patients have abnormal non-tumor proliferation (STB), two patients have abnormal neuronal and glial proliferation or apoptosis (DNET), one patient has an abnormal cortical organization (PMG) and one patient has a abnormal cortical organization (PMG) associated with a neuronal migration abnormality (nodular heterotopias)
Conclusion: In the present study the clinical pictures presented by our patients were similar to those reported in the literature. MCD remains a cause of symptomatic epilepsy which is generally difficult to manage by medical treatment and whose surgery does not yet find an important place.
p04 Anti-glutamic acid decarboxylase antibody associated epilepsy spectrum
Dhaker Turki, Ines Bedoui, Zeineb Brahem, Anis Neji, Mariem Messelmani, Hajer Derbali, Jamel Zaouali, Ridha Mrissa
Department of Neurology- Military Hospital of Tunis, Tunisia
Purpose: The purpose of our work was to characterize the anti-GAD antibodies associated epilepsy.
Method: We included in our study 5 patients, 3 women and 2 men. The mean age of the beginning of the epilepsy was 45,3±3 years old. All of them had pharmaco-resistant epilepsy. Neuro-cognitive disorders were found in 3 cases and movement disorders in two
Results: A moderated lymphocytic pleocytosis was found in CSF examination in 3 patients.
Anti GAD antibodies were positive in the blood in all patients, and in CSF in 3 cases. All patients received intravenous Immunoglobulin therapy with positive outcome in 4 patients.
Conclusion: Anti-glutamic acid decarboxylase antibodies (GAD), initially described in type 1 diabetics, have been recently identified in some patients with epilepsy.Anti GAD antibodies are responsable of a neuronal hyperexitability by inhibating the GABAergic neurotransmission.
A better knowledge of the GAD antibodies associated neurological disorders seems to be necessary for a faster diagnosis and a better treatment.
p05 Autoimmune epilepsy: a retrospective study of a Tunisian cohort
Anis Neji, Ines Bedoui, Zeineb Brahem, Dheker Turki, Jamel Zaouali, Malek Mansour, Ridha Mrissa
Military hospital, Tunis, Tunisia
Purpose: To describe clinical and paraclinical characteristics in patients with autoimmune epilepsy.
Method: Observational retrospective study including 200 cases of epilepsy under the care of our department from 2005 to 2018. Epilepsy was definded according to ILAE 2017 classification. The diagnosis of autoimmune epilepsy was made in ten patients on the basis of clinical presentation, cerebrospinal fluid (CSF), brain magnetic resonance imaging (MRI) and neural autoantibodies. The clinical and paraclinical features of these patients were studied.
Results: Ten patients (5%) with an average age of 39 ±5years had an autoimmune epilepsy. All patients had focal to bilateral tonic-clonic seizures, multifocal seizures semiology, drug-resistant epilepsy and cognitive impairment. Five patients had myoclonia or dystonia. Brain MRI was normal in six patients (60%) at onset, but showed bitemporal abnormalities on subsequent MRI in five patients. CSF investigations showed inflammation signs in six patients. Neural autoantibodies included glutamic acid decarboxylase-65 (GAD-65) in 40% and N-methyl-D-aspartate (NMDA) receptor in 40%. Autoantibodies were absent in two patients. Two patients had ovarian teratoma. All patients received intravenous immunoglobulins or plasmapheresis in association with antiepiletic drugs (AED).
Conclusion: An autoimmune epilepsy should be suspected in patients presenting with an acute or subacute onset of symptoms, psychiatric symptoms, history of neoplasia, AED resistance, multifocal seizures , movement disorders, evidence of central nervous system inflammation on CSF or brain MRI and the exclusion of other causes. Early recognition and treatment of autoimmune epilepsy is paramount as it is associated with better outcomes.
p06 Video-EEG Monitoring/Iraqi Experience
Ghaieb Aljandeel
Iraqi League Against Epilepsy, Baghdad, Iraq
Purpose: To throw light on the new Iraqi experience in Video EEG Monitoring regarding practice, challenges, and problems
Method: Iraqi experience in video EEG Monitoring is a new one starting practically in just five years; there are four centers (three governmental and one private). There are usually one or two patients per day; the duration of Monitoring is 3-12 hours during the day or overnight. The usual tracings include wake and sleep records. 200 hundreds of patients were reviewed among patients in two centers in Baghdad
Results: Ictal events were documented in 10% of patients; 55% of patients showed successful monitoring whether negative or positive results. Abnormal interictal discharges were recorded in 47% of patients. Ictal patterns were noted in 7% of patients only
Conclusion: Video EEG Monitoring when newly practiced is very challenging; it is a double-edged sword. It may be harmful and misleading if not carefully and precisely interpreted. When genuine, Video EEG Monitoring is the gold standard test in epilepsy management.
COMORBIDITIES
p07 The Role of Trained Epilepsy Counselor in Combating Psychological Consequences of Epilepsy in Rural Kenya
Eddie Maraga, Fredrick Beuchi
Foundation for People with Epilepsy, Mombasa, Kenya
Purpose: Epilepsy is common in Kenya, with psychological consequence that can go undetected therefore delaying initiation of interventions. This delayed intervention results into severe psychological distress and even suicide. We examined the role of an incorporating an Epilepsy Counselor (EC) in clinical review to combat adverse psychological consequences of epilepsy in a rural community clinic.
Method: From January 2018 to June 2018, we implemented support groups of adults with epilepsy who attended epilepsy clinic for the first time. Treatment of epilepsy alongside education and counseling was started simultaneously. The education and counseling entailed general information about epilepsy and care, and living well with epilepsy. Participants were followed up monthly over a period of six months to determine psychological functioning using Neurological Disorder Depression Inventory for Epilepsy (NDDI-E).
Results: Of the 43 participants who were attending monthly meetings, 61% (n-26) were female. During the initial visit active depression detected with NDDI-E was 78% (n-34). Significant predictors of depression were poor seizure control and misconception on causation of seizure. Following six month follow up by the EC, 91% (n=32) of the 35 patients who had active depression had significantly lower scores on NDDI-E (p = 0.001) and adherence to medication was observed in 97%.
Conclusion: There was better co-ordination in the epilepsy services when treatment of epilepsy and counseling starts simultaneously. The strategy of using trained EC in epilepsy clinics is a useful strategy that helps in better drug compliance and alleviating psychological distress
p08 Epilepsy and headache
Anis Neji, Ines Bedoui, Zeineb Brahem, Dheker Turki, Malek Mansour, Jamel Zaouali, Ridha Mrissa
Military hospital, Tunis, Tunisia
Purpose: To elucidate the relationship between migraine-like headache and epilepsy
Method: Retrospective study including patients having epilepsy and headache with normal brain imaging.
Results: Twenty-one patients were included in our study. Migraine triggered seizures was described in five versus three cases of ictal headache. Post seizure headache was found in 19 cases. Migraine without aura has been associated to genetic epilepsy.
Conclusion: In view of the high prevalence of misdiagnosis, there is a need for achieving clarity and consensus in headache associated epilepsy.
p09 Review of Partial Onset Status Epilepticus Due To Hyperglycemia Associated With Focal Subcortical Lesion
Talal Aljumah, Ashraf Alharthi, Fayez Alanazi
King Abdulaziz medical city, Riyadh, Saudi Arabia
Purpose: Recognition of a unique clinical radiological entity associated with hyperglycemia induced seizures and Review of the speculated underlying mechanisms.
Method: literature review with Case report and imaging description .
Results: Brain Magnetic resonance imaging showed right paraito occipital subcortical hypointensities in T2 and gradient echo sequences with Cortical gyral hyperintesities and swelling, with no abnormalities in DWI. Upon follow up there was clinical and radiological recovery after well control of blood sugar.
Conclusion: In our case as well as several other reports, hyperglycemia induced seizures can present with characteristic brain MRI abnormalities and specific EEG findings. The clinical recovery with brain MRI reversibility after good glycemic control indicates a unique clinical entity that needs to be recognized early with an appropriate management.
p10 Reasons of epilepsy diagnosis delay in South of Morocco
Naji Yahya, Kissani Najib
Neurology department, University hospital Mohammed VI, Marrakech, Morroco
Purpose: Analyze the diagnosis delay of the disease in south of Morocco and to develop discussions about optimal solutions throw our experience in a third level hospital of Marrakesh Morocco.
Method: We reviewed the medical records of 2000 patients who had been consecutively followed for Epilepsy between January 2000 and October 2018 at neurology department, Mohamed VI University Hospital of Marrakech. The medical records were explored throw pre-established sheets for the patient’s demographic details (age, sex), medical history, date of first consultation , functional call signs, type and frequency of seizures, treatment received and outcome of patients. All data were analyzed by IBM SPSS statistical version 22 software.
Results: We collected 300 patients with Epilepsy. The mean age was 26 years. The majority of patients in our study were male (52%). The majority of patients are from rural regions in 60% of cases. The socioeconomic level is low in 60.8%, average in 37.9 and high in only 1.3%. The main types of seizures were partial seizure with secondary generalization in 42%. In our series the management of epilepsy was pharmacological in the majority of cases. In our study the average diagnosis time for epilepsy was around 8 years and 3 months.
Conclusion: The diagnosis delay of epilepsy in South of Morocco should include wrong prejudices, difficulty of access to health care, costs of medication, and a lack of psychological support. For that we should develop strategies to improve the delay of diagnosis of patients with epilepsy in a multidisciplinary team working with a political will, in order to make the ways of current care better.
DRUG THERAPY
p12 Predictors of response to medical treatment of Epilepsy among Egyptian patients: A single center Study.
Enji Elsawy
Cairo University, Kasr Alaini Medical School, Cairo, Egypt
Purpose: We performed a single center study in Cairo University epilepsy unit (CUEU) to determine the prognostic factors to predict the response of the patients to medical treatment of epilepsy in the early stages of the disease.
Method: This study was done on 857 epileptic patients attending the Cairo university epilepsy unit (CUEU) outpatient clinic.
Patients were divided to two groups based on responding to the medical treatment of epilepsy during last 6 month and clinical, neurophysiological and radiological data were recorded for all the patients to be used in the statistical analyses.
Results: The patients’ mean age 24 ±12.31 yr. There was 181 patients with uncontrolled epilepsy and 676 patient with well controlled seizure.
There was a significant difference between two groups as regards age of onset (p-0.034), male gender ,smoking and history of drug abuse were significant factors in uncontrolled group (p<0.001,0.001,0.002 respectively). Also the prevalence of brain imaging abnormality and other neurologic disorders was significantly higher in patients with uncontrolled epilepsy in compare with patients with controlled epilepsy (p-<0.001).
p13 Levetiracetam behavioral and cognitive side effects in children with epilepsy
Rania Zouari, Siham Ben Nsir, Wafa Bouchaala, Yosra Ghouylia, Fatma Kamoun, Chahnez Triki
Hedi Chaker Hospital, Sfax, Tunisia
Purpose: levetiracetam (LVT) is one of the most prescribed antiepileptic drugs in pediatric patients with epilepsy, shown its proven effectiveness in different types of seizures. Although it’s widely safe and generally well-tolerated with few minor side effects occurring mainly in adults, it may cause some serious adverse reactions.
We report 2 cases of child epilepsy treated with LVT who developed severe behavioral and cognitive side effects.
Method: two children (P1/P2) with acute onset of behavioral problems and cognitive impairment within few months after LVT initiation for epilepsy with focal motor seizures, are reported.
Results: They were a girl and a boy aged respectively of 3 and 20 years-old, from non-consanguineous parents and normal milestones. P1 was initially treated with valproate switched to LVT due to hyper-ammonemia, while P2 had epilepsy uncontrolled by carbamazepine and stopped after occurrence of cataract. Both patients had history of prior abnormal behaviors and cognitive regression after epilepsy onset. After switching to LVT, both had good control of their epilepsy, but a worsening in their cognitive development. P1 started having alteration of communication and social abilities and lost autonomy. However, P2 became totally dependent of his parents with severe impairment of his semantic memory and speech abilities. Once LVT was stopped, both patients showed significant improvement within weeks.
Conclusion: LVT appears to be effective in controlling severe epilepsy in children. Nevertheless, the risk of developing behavioral and cognitive impairment seems to be unknown and misdiagnosed, especially in children with pre-existing mental retardation or behavioral abnormalities. Yet, the cognitive impairment triggered by LVT usually improves after drug cessation
p14 Therapeutic profile of epilepsy at the University Hospital of Marrakech (Morocco)
Oussama Cherkaoui Rhazouani, Najib Kissani
University Hospital Mohammed VI, Marrakech, Morocco
Purpose: Epilepsy is one of the most common neurological diseases. The treatments for epilepsy range from therapeutic expectancy to antiepileptic drugs or even surgery. Through our work we have tried to describe the therapeutic profile of epileptic patients followed in the neurology department at the University Hospital Mohammed VI in Marrakech.
Method: Retrospective study of the profile of 1017 patients followed for epilepsy for 16 years, in the neurology department at the University Hospital Mohammed VI in Marrakech. Each medical file was analyzed for demographic aspects, medical history, clinical data and complementary examinations. The etiologies, the therapeutic attitude and the evolution were also noted.
Results: 1017 patients were included in this study. Their median age was 24.4 years, with extremes ranging from 3 months and 10 days to 85. The age group of 15 to 34 years was the most frequent (43.75%). The male was the most represented (53.7%), with a sex ratio of M / F = 1.1. The median age of onset of first seizures was 15.6 years. Partial seizures with secondary generalization were the most frequent with a percentage of 39.33% followed by generalized seizures (31.17%) and simple partial seizures (15.33%). the most common type was idiopathic epilepsy. The treatment of epilepsy was often based on a one drug (88.4%). In these monotherapies, the most prescribed drugs were carbamazepine (43.46%), valproate (31.76%), and phenobarbital (5.70%). 109 patients were treated with dual therapy. The carbamazepine-phenobarbital combination was most frequently used (3.14% of cases).
Conclusion: Epilepsy remains a public health problem, especially in developing countries where access to new therapies is restricted. In addition, negative prejudices surround the disease constitute another obstacle to the care, development and social integration of patients.
EDUCATION
p15 Why a delayed diagnosis among Marrakesh epileptic patients
Mustapha Chaqda, Najib Kissani
University hospital Mohammed VI, Marrakesh, Morocco
Purpose: Epilepsy is affecting about 69 million people worldwide, with 90 percent living in low- and middle-income countries (LMICs). In Morocco, even though epilepsy is treatable, approximately 70 % of people with epilepsy do not receive effective treatment, epilepsy still constitutes a serious health problem. How often the diagnosis of epilepsy is delayed in Marrakech’s patients, the reasons for the delay and its impact on the evolution of the disease, are questions that we tried to put some light on in this study.
Method: This is a retrospective descriptive study conducted on a sample of 132 patients from neurology Out-patients clinic of Marrakesh university Hospital Mohammed VI.
Results: Among the 132 patients, 62 % were diagnosed with epilepsy after a period of delay. Of 82 patients whom epileptic diagnosis been delayed, 35.4% were females and 64.6% were males. Most patients were in the range of 20 to 39, with 36 identified patients or 43.9 % of cases. The median of diagnosis time was 6 years. 18.3% (n=15) of patients were diagnosed within 1year after the first seizure, while 33% (n=27) were diagnosed within a period longer than 6 years. We clearly notice that half of our patients (n=41) admitted using maraboutic methods.
Conclusion: Defining the causes of the delayed diagnosis of epilepsy among Marrakesh patients is critical for the evolution of the disease, the cultural and socioeconomic status are some of the most important factors depicted in our study.
p16 How can we improve education of patients with epilepsy using telemedicine? (Moroccan experience)
Najib Kissani
Neurology Department, Marrakech University Hospital & Research Medical center of Marrakech Medical school, Marrakech, Morocco
Purpose: Telemedicine encompasses the whole range of medical activities (including diagnosis, treatment and prevention of disease, continuing education of health-care providers and consumers, and research and evaluation),
it includes also all kind of social activities dedicated to educate, sensitize and assist patients with epilepsy.
Method: Authors evaluated improvement of knowledge and awarness using telemedicine, in patients with epilepsy during 3 years (2015-2017), in Marrakech, in cities (Essaouira & safi) of South Morocco and in in 2 cities of North Morocco (asilah & Larache)
Results: ovement During these during 3 years, we noticed a significant improvement in knowledge and awarness in patients with epilepsy, telemedecine sessions were very regular with Safi in the South than Essaouira and with Asilah in the North than Larache; we found that the associations’ members who coordinate the telemedecine sessions were very enthousiastic and spread our exeprience with them to other associations, who asked us to start such experiences with them (like in Tangier, Tinghir, Khenifra and other cities).
Conclusion: The use of new technologies in epilepsy education and sensitization is very useful, especially in Morocco, as in other developing countries, where spepcialists are missing; because of the easy use, the saving money and time for both patients, families and especially physicians, and the possibility of communicating 2 teams or even more in same time and sharing educational and sensitization programmes without any border.
EPILEPSY SURGERY
p17 Refractory spasms of focal onset – a potentially curable disease that should lead to rapid surgical evaluation
Mathilde Chipaux, Georg Dorfmuller, Martine Fohlen, Nathalie Dorison, Olivier Delalande, Emmanuel Raffo, Sarah Ferrand-Sorbets, Delphine Taussig
Rothschild Foundation, Paris 19, France
Purpose: Infantile spasms (IS) can occur as the only seizure type in children with surgically amenable epilepsies. Although early surgery has shown positive effects, little is known regarding outcomes.
Method: We retrospectively reviewed all children with IS referred to our tertiary center between 2002 and 2014 and try to define factors of outcome.
Results: Sixty-eight children with focal onset were referred: twenty children with a hemispheric implication and 48 with one or more lobes involved. The age of onset was significantly earlier in the hemispheric population (8.0 versus 16.7 months in the focal population). There was no difference in the age of onset between anterior and posterior onset zones, as we could expect regarding the maturation gradient. The epilepsy began earlier in life in tuberous sclerosis than in DNET. Only 3 children of the 48 non-hemispheric patients had a normal MRI at the time of the surgery. Temporal lobe was involved only in a third of the population. More than 86% of the patients were operated on. Patients with hemispheric lesions were operated on younger (2.6 years +/- 2.1 years) compared to 4.6 +/- 3.5 years in the whole population. The most frequent etiologies were in descending order: dysplasia, ganglioglioma or dysembryoplastic tumours and tuberous sclerosis. The global seizure outcome was favorable (Engel 1a) in 74.6% of the patients, and 87.9% if the delay between the first seizure and the surgery was less than 36 months. It fell to 64.7% if the delay exceeded 50 months.
Conclusion: Focal spasms have a similar postsurgical outcome as other seizure types so surgery may be an excellent option for treating selected patients with focal infantile spasms. Volume and type but not topography of the lesion influence the age of onset. MRI is very helpful to locate the pathology in the pediatric population, since only a small portion had a normal MRI.
p18 Callosotomy: an effecient surgical treatment for drop attacks in a large pediatric series
Sarah Ferrand Sorbets, Delphine Taussig, Olivier Delalande, Christine Bulteau, Nathalie Dorison, Mathilde Chipaux, Georg Dorfmuller, Martine Fohlen
Rothschild Foundation, Paris, France
Purpose: Corpus Callosotomy is a palliative neurosurgical treatment for patients with either generalized or multifocal refractory epilepsy and drop attacks
Method: We report a retrospective series of 50 patients operated at the Rothschild Foundation between 2003 and 2017
Results: Callosotomy was total in 45 patients and anterior two-thirds in 5 patients (older than 10 years). Patients had cryptogenic epilepsy in 20 and symptomatic in 25. All had traumatic falls (tonic, atonic, myoclonic or infantile spasms) in the context of Lennox-Gastaut, multifocal epilepsy or rebel spasms. Fifteen patients had more than 3 types of seizures. With respect to our total callosotomy population, mean age at surgery was 8 years. According to Engel’s classification, 11% of patients were Engel 1, and 49% Engel 2 + 3. Forty-nine percent were free of seizures related to drop attacks. Mean follow-up was 3.4 years (3 months-12.5 years). The overall complication rate was 6%. Spasms in the clinical history, less than 3 seizure types, or the presence of a lesion seem to have a better prognosis regarding drop attacks. Concerning anterior two-thirds callosotomy, mean age at surgery was 13 years. Three patients were Engel 3, and 2 patients Engel 4 (1 death due to SUDEP) but the small number of patients does not allow to give conclusions or even trends
Conclusion: Callosotomy remains a palliative surgery, with a low complications rate, more efficient when performed total. The existence of infantile spasms seems to be a predictor of better outcome.
p19 Surgery of epilepsy in developing countries, why to be delayed?
Najib Kissani1, Reda Ouazani2, Sanaa Nafia3, Yiledoma Thierry Modeste Lengane4, Ali A. Asadi-Pooya5, Boulenouar Mesraoua6,7, Lilia Nunez8
1Neurology department marrakech University Hospital & Research Medical center of Marrakech medical school, Marrakech, Morocco; 2Rabat speciality Hospital, University center Ibn Sina, Rabat, Morocco; 3neurology department, University Teaching Hospital Mohammed VI, Marrakech, Morocco; 4Department of Neurology, University, Teaching Hospital Yalgado Ouédraogo, Ouagadougou, Burkina Faso; 5Neurosciences Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; 6Hamad Medical Corporation, Doha, Qatar; 7Weill Cornell Medicine-Qatar, Education City, Doha, Qatar; 8Faculty of Medicine of the National Autonomous University of México, México
Purpose: Describe/define the State of the art of Epilepsy Neurosurgery (NS) in developing countries
Method: We started this study all over the word, prospectively disseminated through a questionnaire addressed to main epileptologists and neurologists involved in epilepsy, in major developing countries and in some developed countries all over the world.
Results: results of the prospective study included data from 20 African countries, 10 Asian countries, 4 latine American countries and 4 European countries.
Authors suggest 5 categories in term of developement of Epilepsy Surgery:
available…)
4.Burkina Faso (started punctually with help of foreign experts)
5-No surgery.
Conclusion: There is a real need of starting neurosurgery of epilepsy in developing countries. ILAE and IBE and other organisms like WHO and WFN should help and assist emerging and developping countries to start this specialized surgery and to have more collaboration and exchange of exepriences between countries of defferent level in term of epilepsy surgery.
GENETICS
p20 HYPERHOMOCYSTINEMIA IN EPILEPTIC PATIENTS: THE ROLE OF THFR POLYMORPHISM AND ANTIEPILEPTIC DRUGS
Mohammed Mahdy, Nesma Ghonemi
Faculty Of Medicine Zagazig University, Zagazig, Egypt
Purpose: analyses the effect of a C677T polymorphism of MTHFR and antiepileptic drugs (AEDs) on homocystine (tHcy) levels in patients with epilepsy treated with monotherapy including the traditional and newer AEDs
Method: Ninety two healthy control who had no clinical and/or laboratory evidence of metabolic and/or endocrine diseases were included. complete blood count, liver and kidney function tests and serum levels of folic acid and tHcy. DNA was extracted from peripheral blood using the QIAamp DNA Blood Mini Kit. Genotyping for C677T MTHFR polymorphisms was carried out on DNA extracted from white cells of freshly drawn peripheral blood samples.
Results: Mean tHcy values were significantly higher in patients than in controls (17.3 ± 3.2 vs 6.9 ± 2.2 ; p < 0.001). A significant difference in plasma tHcy values was also seen across patients stratified on the basis of pharmacogenetics .Hyperhomocysteinemia was observed in patients on carbamazepine (CBZ),
phenobarbital (PB), topiramate (TPM), and oxcarbazepine (OXC) therapy, especially in TT677 MTHFR genotype.
Conclusion: TPM and OXC among of the recent AEDs can cause hyper-tHcy as the old ones, whereas lamotrigine (LTG) and levetiracetam (LEV) are devoid of this effect.
NEUROIMAGING
p21 Atypical Cerebral Imaging in Lafora Disease
Naima Sghaier, Rafik Machraoui, Saida Jerbi, Samia Younes
Hospital University Tahar Sfar, Mahdia, Tunisia
Purpose: Imaging of brain in Lafora disease is not specific but many cases reported in the literature revealed diffuse cortical atrophy especially in occipital lobe. To our knowledge, no study has reported the presence of important occipital atrophy with porencephalic cysts.
Method: case report
Results: We report an atypical radiological aspect of this disease in two sisters showing an important occipital atrophy with porencephalic cyst. Lafora disease was confirmed by cutaneous biopsies.
Conclusion: The atypical radiological aspect found in our two observations prompts us to study brain imaging during ML on a larger number of patients and to look for correlations with the clinical and genetic aspects of this disease.
p22 Functional Connectivity of Memory in Temporal Lobe Epilepsy
Sarah Buck1, Lorenzo Caciagli1, Sjoerd Vos1, Gavin Winston1, Pamela Thompson2, Matthias Koepp1, John Duncan1, Meneka Sidhu1
1Institute of Neurology, London, United Kingdom; 2Epilepsy Society MRI Unit, Chalfont St Peter, United Kingdom
Purpose: Functional magnetic resonance imaging (fMRI) has previously demonstrated functional reorganisation of memory representations in people with Temporal Lobe Epilepsy (TLE). Less is known about the connectivity within the memory network. The aim is to examine memory network reorgansation in people with TLE.
Method: We studied 77 patients with unilateral TLE (37 left) and 27 controls. All participants performed a memory encoding fMRI paradigm of faces and words. Psychophysiological Interaction (PPI) analysis was conducted to examine brain regions that were correlated with the time-course in the left and right hippocampi, for words and faces respectively. PPI activations were correlated with verbal and visual memory scores to examine the efficacy of network connectivity.
Results: During word encoding, controls showed greater connectivity from the left hippocampus to the prefrontal cortex compared to left TLE (T=4.599, p<0.05, FWE corrected). During face encoding, controls showed greater connectivity from the right hippocampus to the fusiform gyri bilaterally compared to right TLE (T=1.659, p<0.05). Compared to controls, left and right TLE groups showed greater connectivity to posterior hippocampi bilaterally during word and face encoding.
Left TLE patients with better verbal memory showed greater connectivity to the ipsilateral lateral temporal lobe (T=1.692, p<0.05). Right TLE patients with better visual memory showed greater connectivity to the fusiform gyri bilaterally (T=1.691, p<0.05).
Conclusion: We report widespread memory network reorganisation in people with epilepsy. This has important implications in the planning of epilepsy surgery and a network approach may be helpful in the prediction of memory outcome after surgery.
p23 Seizures are bad for brain’s health
Jalami Nezha, Chraa Mohamed, Kissani Najib
Hospital Mohammed VI, Marrakech, Morocco
Purpose: This study aims to determine, through a case report, acute changes in magnetic resonance imaging (MRI) that may be induced by status epilepticus.
Method: case report and literature review
Results: 28-year-old patient, no known epileptic. Was hospitalized for a state of epilepticus inaugural, the clinical examination was without particularity, the magnetic resonance imaging showed abnormalities in hyposignal T1 and hypersignal T2 and FLAIR bilateral and asymmetric, in the thalamus, the cerebellum, and in cortex. The etiological assessment was negative, the patient received only antiepileptic drugs during hospitalization. A control MRI was requested after 3 months which showed a spectacular spontaneous regression of the lesions.
Conclusion: Recent advances in magnetic resonance imaging (MRI) offer new possibilities for identifying early neuronal damage associated with seizures
NEUROPSYCHOLOGY/PSYCHIATRY
p24 Depression and self-stigma in patients with epilepsy.
Izumi Kuramochi1, Naoshi Horikawa2, Sakie Shimotsu3, Toyohiko Hiwatashi4, Masako Watanabe5, Mitshutoshi Okazakia6, Koji Matsuo1, Toshio Ota1
1Saitama Medical University, Saitama, Japan; 2Saitama medical university Kawagoe clinic, Saitama, Japan; 3Kyoto Womens university, Kyoto, Japan; 4The Maruki memorial medical and welfare center, Saitama, Japan; 5Shinjuku Neuro Clinic, Shinjuku, Japan; 6National Center of Neurology and Psychiatry, Tokyo, Japan
Purpose: Self-stigma occurs when people internalize these public attitudes and suffer numerous negative consequences as a result. Self-stigma is factor that prompts patient with epilepsy(PWE) reject participating in society and treatment. Self-stigma is a mediator between cognitive schemata and depression. This study aimed to consider factors of depression and self-stigma in PWE.
Method: Ten PWE were selected in psychiatry outpatient clinics. The average age is 38 ±16.1years, the sex ratio was M:F=4:6. Based on the categories of epileptic symptoms, there were five patients with focal epilepsy and also five patients with generalized epilepsy. Transcribed interviews and field notes were analyzed using qualitative content analysis method. In addition, we performed the Beck depression inventory (BDI) , Rosenberg’s self-esteem scale(RSES) and The stigma scale for chronic illnesses 8-item version (SSCI-8) to compare the result of quantitative data with the result of qualitative data. Statistical analyses were performed using Spearman’s correlation coefficient. This research was approved by the national center of neurology and psychiatry ethics board.
Results: We analyzed word for word and were able to confirm 209 cords in conjunction with stigmata of epilepsy. There were five patients diagnosed as depression by BDI (mean score 18.1±18.8). The inverse relationship between BDI and RSES score was r=-0.81, P=0.005, SSCI-8 and RSES score was r=-0.49,P=0.151.
There were no significant correlations between the number of the word for word and each qualitative scores. The patient of a moderate depressed mental state tended with much number of the word for word (P=0.25).
Conclusion: The study shows that the low self-esteem of the PWE leads to depression among the patients. Reducing the self-stigma of the epilepsy patient has a good influence on self-esteem of the patients, and it is considered as an important element to raise the degree of the social participation of the patients.
PAEDIATRIC EPILEPTOLOGY
p25 Rare Neurological complication of Nasal Desmopressin for Nocturnal Enuresis in Children
Reem Alyoubi, Jomana Nassir
King Abdulaziz University, Jeddah, Saudi Arabia
Purpose: Desmopressin is used to treat nocturnal enuresis, it is taken either intranasally or orally however the intranasal route is not recommended for pediatric patients due to reports of seizure attacks as an adverse reaction. (1)
The use of intranasal desmopressin has uncommonly resulted in electrolyte imbalance, including sodium level disturbance. (2)
We present a case of seizure attacks in a healthy 10-year-old male, due to usage of intranasal desmopressin for nocturnal enuresis.
Method: 10-year-old male patient, not known to have any medical illnesses, brought to the ER with history of 4 seizure attacks, generalized tonic-clonic jerks in upper and lower extremities, on the same day of presentation within 5 hours. He is not known to have epilepsy. Seizure was controlled with medication. During the seizure, he had vomiting and diarrhea. Previous history of febrile seizure at 18 months. Initially mother denied any drug ingestion, but later she mentioned that her child had been on desmopressin nasal spray, unsupervised. The dose taken for 1 month is unknown, there was no follow up.
He was immediately admitted to the PICU to stabilize the seizure, seizure was controlled after 4 days. During the 4 days the following investigations were abnormal,Electrolytes showed
Neuroimaging and lumbar puncture were normal.
EEG showed postictal slowing.
Results: Since hyponatremia is a known complication of intranasal desmopressin parents should be aware of this side effect. (1) A similar case of a 10-year-old healthy child experienced the same complication of seizures after 7 months of using desmopressin for nocturnal enuresis.
Parents should also be aware of how drinking excessive fluids can enhance the effect of hyponatremia and thus increase the risk of developing a seizure attack. (3)
Lucchini et al, mentioned that 22 out of 54 cases had taken excess fluid intake as a along with desmopressin which enhanced hyponatremia. Therefore, fluid intake should be limited from 1 h before to 8 h after administration of desmopressin, also desmopressin should be interrupted during illness which results in electrolyte imbalance such as fever, vomiting or diarrhea (4).
Conclusion: It is evident that hyponatremia can rarely cause seizures in children using intranasal desmopressin. Doctors must educate parents of this rare side effect so that parents can make their decision on taking the medication accordingly. Furthermore, parents should also be aware of the precautions taken to avoid hyponatremia, including fluid intake and electrolyte imbalances due to illness.
p26 Ketogenic diet: state of use and difficulties of a tunisian Center
Ben Mohamed Dina, Bouchaala wafa, Ben Nsir Sihem, Kammou Fatma, Triki Chahnez
Neurologic Pediatrics Department, Hédi Cheker hospital, Sfax, Tunisia
Purpose: Elaborate the state of the ketogenic diet in a Tunisian cohort (frequency, success rate, different practical barriers, quality of follow-up)
Method: A retrospective 3-year study (2016-2018) on patients’ files classified as ketogenic diet. Diet details were identified: hospitalization number and age of onset, adverse effects, tolerability, quality of medical follow-up.
Results: We collected 9 patients of middle age 5.2 years (3 years – 8 years) and sex ratio (M/F) = 0.8. The traditional ketogenic diet (3:1) was applied to 2 patients in 2016, 1 in 2017 and 6 patients in 2018, after using an average number of epileptic drugs of 3.8. Eights patients had a history of epileptic encephalopathy while the remaining child had glucose transporter deficiency. The initial work-up pre-diet was complete only in 22%, the neuropsychological test was missed in 5 patients and chromatography in 3 patients. Diet was introduced in hospital in all patients in a 15 days on average-hospitalization. All patients were ketotic by 48 hours after diet (trace to moderate), and only one was lethargic with gastro-intestinal side effects (vomitting and constipation). At the follow up, a decrease of seizures was noticed in 7 patients. The diet was not accepted by almost half of the children and only one patient abandoned it. Parent’s major difficulty was the high cost of ketogenic diet in 2/9.
Conclusion: The prescription of ketogenic diet in our Center increased though the last three years, and reached 6 prescriptions in 2018, comparable with french series, in intractable epilepsy after the use of more than 3 Anti epileptic drugs. The lack of experience explains the incompleatness of initial and follow-up work up. The non acceptance of diet by the child and its high cost constitute a barrier in the maintien of diet, but it doesn’t influence its efficency.
p27 Paradoxical effect of antiepileptic drugs: case report
Olfa Jallouli, Wafa Bouchaala, Sihem Ben Ncir, Fatma Kamoun, Chahnez Charfi Triki
Hospital Hedi Chaker, Sfax, Tunisia
Purpose: indicate the side effects of antiepileptic drugs and the management of the treatment of children followed for epilepsy
Method: We describe the clinical case of a child followed for epileptic encephalopathy under polytherapy who had an aggravation after the addition of Sulthiam.
Results: We report the case of a 9 years old child with epileptic encephalopathy of genetic etiology. Several treatments were introduced (valproate, clobazam, ethosuximite), corticosteroids and ketogenic diet but still have electric status epilepticus without seizures. It was proposed to add Sulthiame to reduce the electric discharges. However, he presented language regression, behavioral disorders, hyper-sialorrhea and difficulty of chewing. Two months later, he was hospitalized for status epilepticus with multiple seizures types (tonic, clonoc, absence) treated by intravenous clonazepam. The seizures disappeared and the EEG abnormalities persisted with Sultiame discontinuation.
Conclusion: The knowledge of the therapeutic mechanism of AED is primordial to describe the best drug. However the effect of the association of multiple AED is still unknown and may worsen the epilepsy instead that is why it should be considered before prescribing multiple drugs.
p28 Validation of a Hausa Epilepsy Screening and Seizure Classification Tool
Aminu Taura Abdullahi1, Umar Sabo1, Halima Adamu1, Auwal Salihu1, Usman Wudil2, Zubairu Iliyasu1, Juanita Prieto Garcia2, Edwin Trevathan2
1Aminu Kano Teaching Hospital, Kano, Nigeria; 2Vanderbilt University Medical Center, Nashville, TN, USA
Purpose: Development and validation of a Hausa epilepsy screening and seizure type classification tool, for use by community health workers (CHWs).
Method: An epilepsy screening tool was expanded and translated to Hausa to enhance recognition of specific seizure types and epilepsy syndromes . A “yes” answer to any of 3 screening questions prompted 15 questions to elicit details of the events. Following consent, epilepsy-trained CHWs administered the tool to mothers of 765 children at local clinics in Kano, using tablet-based REDCap software. Eighty-two children who screened positive plus 63 randomly selected children who screened negative, were evaluated by epileptologists; the epileptologists’ diagnosis and seizure type classification was considered the gold standard. A pediatric epileptologist (E.T.) recorded the diagnosis of epilepsy and the seizure type, based upon the screening tool results, blinded to the results of the physician evaluations.
Results: The sensitivity of the tool for epilepsy was 0.95 (95% CI= 0.90, 0.99) and the specificity was 0.88 (95% CI = 0.80, 0.96). The positive predictive value for epilepsy was 0.90 (95% CI = 0.84, 0.97), and the negative predictive value was 0.94 (95% CI = 0.88, 0.99). Among those children who screened positive for epilepsy, the predictive value of a positive screen for generalized seizures was 1.00 (95% CI = 0.90, 1.00) and the predictive value of a negative screen for generalized seizures was 0.73 (95% CI = 0.59, 0.86).
Conclusion: This Hausa language epilepsy screening and seizure type classification tool, administered by CHWs, has been validated for screening in clinic populations.
p29 Temporal lobe epilepsy: study of 31 pediatric cases
Nadia Bouattour, Wafa Bouchaala, Olfa Jallouli, Sihem Ben Nsir, Fatma Kammoun, Chahnez Triki
Department of pediatric neurology, Sfax, Tunisia
Purpose: Temporal lobe epilepsy is the most common form of focal epilepsy. Clinical manifestations are polymorphic and often misleading. The purpose of our study is to describe clinical, electroencephalographic(EEG), radiological and therapeutic aspects of temporal lobe epilepsy.
Method: A retrospective 10-years study (2008-2018), on patients’ files classified as temporal lobe epilepsy. Patients details were identified while neurologically examinated, EEG, brain imaging and neuropsychological evaluation. We have specified for each patient the evolution under treatment.
Results: We collected 31 patients. The average age of patients at the first examination was 9.2 years [21 months-23 years]. The middle age 6.7 years of onset of epilepsy . A history of febrile seizure found in (19.3%) of patiens. Family history of epilepsy found in (22.58%). Auras preceded seizures were seen in (32.25%). Seizures were focal motor in (80.64%). EEG performed in all patients showed temporal abnormalities. Cognitive disorders were observed in the majority of cases. Cerebral MRI showed an expansive process in (16.12%), hippocampal sclerosis (16.12%), hippocampal atrophy (19.35%), cortical dysplasia(3.22%), it was normal (41.93%) and not practiced in 1 patient. The most commonly used drugs were carbamazepine, valproate and Benzodiazepine. Only 1 patient with pharmacoresistant epilepsy underwent a vagal nerve stimulation. Evolution was favorable (54.83%), stationary (32.25%), resistant (6.4%) and 3 patients never return back.
Conclusion: Clinical manifestations of temporal lobe epilepsy are variable. Etiologies are heterogeneous. The response to medical treatment is favorable in half of the cases. Cognitive disorders are very common.
SOCIAL ISSUES/NURSING
p30 Epilepsy and fasting during Ramadan
Amal Satte1, Youssouf Benmoh2, Amine Reggabi2, Bourazza Ahmed1, Jamal Mounach2, Fatiha Lahjouji3
1Mohammed V Teaching Military Hospital – Mohammed V University of Rabat, Rabat, Morocco; 2Mohammed V Teaching Military Hospital, Rabat, Morocco; 3Clinical Neurophysiology Department, Specialty Hospital, Rabat, Morocco
Purpose: Ramadan is the ninght month of the lunar calendar during which muslims refrain from eating and drinking from sunrise to sunset. This entails changes in dietary habits, sleep hygiene and drug regimens that could influence the course of chronic diseases. The objective of our study was to assess the impact of intermittent fasting during Ramadan on epilepsy.
Method: This study of cohort included 60 epileptic patients who choosed to fast during Ramadan. They were asked to reply to a questionnaire about the number of seizures before and after Ramadan, drug regimens, sleep habits ect… Data was analyzed using SPSS 13.01
Results: The median age was 29,50 years [21–48,50] and 60% were females. 68,3% took their medication twice a day. 46,7% slept less and 76,7% had a sleep phase delay during Ramadan. Only 5% of patient presented more seizures during Ramadan, while 46,7% remained stable and 48,3% improved.
Conclusion: Our study shows that despite changes in hours of sleep, dietary habits and timing of drug intake, most of our epileptic patient were able to fast without exacerbation of their seizures. 48,3% even improved during Ramadan, which highlights the positive effect of intermittent fasting on seizures.
STATUS EPILEPTICUS
p31 Non-convulsive status epilepticus in adult: A Case Report
Elmouden Hafida, Louhab Nissrine, Kissani Najib
Neurology department University teaching Hospital Mohamed VI and Medical Research Centre of medical school of Marrakesh; Morocco
Purpose: NCSE as a potentially curable disease, should be terminated rapidly and strong suspicion of diagnosis is essential to prevent patients from serious injuries, particularly if consciousness is impaired.
Method: The authors describe the case of a 76-years-old man with non-convulsive status epilepticus (NCSE) who had progressed well under treatment.
Results: We report a 76-years-old male patient with type 2 diabetes under insulin for 9 years, known hypertensive for 2 years under treatment, also followed for renal failure for 3 years, under nephroprotective treatment and for a year the patient presents recurrent encephalopathy which resolved spontaneously, initially made of brief confusion then state of agitation followed by confusion, admitted in our department for etiological assessment of a 3rd episode made of hallucination and agitation evolving since a week complicated of consciousness disorders with CRS: 13 /15.The neurological examination was normal. The biological assessment returned normal. MRI brain was normal outside moderate corticocortical atrophy. The EEG with valium test showed generalized epileptic abnormalities that fade after valium injection confirming the diagnosis of non-convulsive epilepsy. The patient was treated with keppra 100 mg / day and the evolution was favorable marked by the disappearance of seizures.
Conclusion: NCSE should be terminated rapidly to prevent patients from serious injuries, particularly if consciousness is impaired.
