The Quality of life among adult Sudanese patients with epilepsy

Introduction: Epilepsy is the most common serious brain disorder worldwide, the impact of it on quality of life can be substantial with far-reaching and life-long consequences despite all this very few studies have been carried out on the QOL in epilepsy. Objectives: To investigate the quality of life in adult Sudanese patients with epilepsy attending Daoud charity clinic June to July 2018.Methodology: Thirty six adult Sudanese patients with epilepsy were included in the study, a multi item questionnaire graded scale and check list to explore the demographic characteristics were used to assess the impact of epilepsy on QOL. Respondents were adults aged at least 18 years old with a diagnosis of epilepsy for more than 3 months the unpaired t-test or one way analysis of variances was used to compare means of QOL scores between groups. Results: Out of 360 patients 190 were males and 170 were females, the mean of age was 34.81.The most frequent type of epilepsy according to the ILAE classification was the generalized tonic clonic (78.4% of patients) .40.5% of patients had < 1 seizure per month during last year while 40.5% had more than 1 seizure per month and 16.2% were free of seizure during last year. The mean total score QOLIE-31 of this study was 43.97_+ 4.78 .Sex, age and marital state did not affect QOL scores. The study showed that type of seizure and duration of epilepsy did appear to be predictive of HRQOL .Adverse effects of antiepileptic drugs (AEDs) have a considerable impact on quality of life and contribute to treatment failure in up to 40% of patients Conclusion: The decrease in overall score of quality of life in adult Sudanese patients is multifactorial.

Management of symptomatic epilepsy after surgery due to drug resistance

The issue of managing patients who were operated due to drug resistance has not been accomplished not only in Ukraine, but throughout the world. But these patients exist, their number is growing, and the neurologists who observe them need a direct understanding of this process. Nowadays, there is no enough evidence base to substantiate rational recommendations regarding the post-surgical drug treatment. Despite the fact that the International League Against Epilepsy (ILAE) classification and the classification previously proposed by J. Engel Jr have many headings that indicate the improvement of patients and possible improvement in their quality of life, the treatment that has achieved seizure control can be considered successful only in patients who meet qualification point 1 according to the ILAE classification or IA according to the Engel classification, and only those who meet these criteria for at least one year. This understanding is very important when choosing further therapeutic management. Taking into account the fact that after surgical treatment the drug resistance should be overcome, further drug treatment should be carried out in the same way as in patients without drug resistant epilepsy. The issue of managing people with epilepsy who received surgical treatment due to drug resistance requires further studies, especially in the context of an increase in the number of such patients. The authors indicate that all the questions and aspects that were presented in the work are controversial and can be adjusted depending on the clinical situation.

Stereotactic radiofrequency thermocoagulation and resective surgery for patients with hypothalamic hamartoma

OBJECTIVEIn this study, the authors compared the efficacy and safety of stereotactic radiofrequency thermocoagulation (SRT) and resective surgery (RS) for patients with hypothalamic hamartoma (HH).METHODSThe authors included all patients with HHs who were treated by SRT or hamartoma resection. Seizure outcomes were assessed by blinded observers according to the International League Against Epilepsy (ILAE) classification. Favorable seizure outcomes were defined as ILAE classes 1 and 2, and unfavorable seizure outcomes were defined as ILAE classes 3–6.RESULTSTwenty-nine patients who underwent SRT or RS met the inclusion criteria; 3 were excluded because they had completed less than 12 months of follow-up. Most of the patients (20 of 26; 76.9%) had small HHs (i.e., maximum HH diameter less than 20 mm). The patients’ follow-up time ranged from 12 to 66 months (median 60 months). At the last follow-up, favorable outcomes were observed in 9 patients (69.2%) who had undergone SRT and 10 patients (76.9%) who had undergone HH resection. No significant difference was found in seizure outcomes between SRT and RS recipients. Patients with giant HHs were more likely than patients with smaller tumors to undergo multiple resections (p = 0.043, univariate logistic regression; significant). However, no significant difference was found between SRT and RS recipients in terms of the number of procedures per patient. SRT recipients had fewer and less-severe adverse events than RS recipients.CONCLUSIONSFor patients with small HHs, SRT provides similar seizure outcomes to RS with a less invasive procedure. Patients who underwent SRT experienced fewer and lighter adverse effects than patients who had RS. Patients with giant HHs were more likely to undergo multiple HH resections.

Classification and management of epilepsy and epileptic syndromes in a cohort of 202 school children- a 2 year follow up study- Sudan

Background In this paper, seizure types, and epilepsy syndromes are elucidated as per ILAE (2010) classification. A brief outline of the antiepileptic drug regimens used and the outcome of seizure control in a two -year period is presented. The applicability of the ILAE classification in resource limited countries has been revisited. Methods This is a descriptive prospective study, in which 202 patients were enrolled. The Cohort group was seen and evaluated by a pediatric neurologist at the Pediatric neurology Outpatients Department (OPD). Epilepsy was classified using the International League Against Epilepsy (ILAE) classification (2005–2009) report. All patients had an Electroencephalogram (EEG) at the start of the study, and this was repeated as deemed appropriate. Brain imaging (MRI) was done to patients when indicated. Treatment decisions were made by pediatric neurologists. Outcomes were categorized into four groups: fully recovered, well controlled, partially controlled and uncontrolled. Results The mean age is 10.5 + 2.7 years. Male to female ratio was 1.7: 1. Thirty five (17.3%) patients had generalized onset seizures, 46(22.8%) had focal onset seizures, 104(51.5%) had a specific epilepsy syndrome, and 17(8.4%) patients were unclassified. 170 (84.2%) patients were on mono-therapy on their initial visit, 30(14.8%) were on two Antiepileptic Drugs (AEDs) while two (1.0%) patients were on poly-therapy. After 2 years; 155(76.7%) patients were on mono-therapy, 36(17.8%) on two AEDs while ten were (4.0%) on polytherapy. One eighty (88.2%) patients were controlled. Fifteen (7.4%) of them were off medication after being seizure free for 2 years. Twenty (9.8%) have partial control, while two (1.0%) patients were uncontrolled. Patients with focal epilepsy, those on polytherapy and those with abnormal imaging had poor prognosis. Conclusions The ILAE classification can be used in resource limited countries. Childhood epilepsies have a good prognosis provided they are well classified and treated.