PO18-WE-51 Temporal lobe epilepsy surgery: a non invasive presurgical protocol, Moroccan experience

19th World Congress of Neurology, Poster Abstracts / Journal of the Neurological Sciences 285 S1 (2009) S155–S339

PO18-WE-48 Association between antiepileptic drug usage and osteopenia/osteoporosis S. Hanchaiphibulkul, S. Towanabut, T. Tantirittisak, T. Worakijthamrongchai. Prasat Neurological Institute, Bangkok, Thailand Purpose: Previous studies suggested that antiepileptic drugs (AEDs) had a direct effect on bone turn over rate and patients with long term AEDs usage frequently had osteopenia or osteoporosis which determined by increased loss of bone mineral density (BMD). Objective: The study was to determine the association between usage of AEDs and osteopenia or osteoporosis. Method: A cross-sectional study of 80 epileptic patients taking antiepileptic drug for more than 1 year compared to 80 controls without epilepsy. Osteopenia or osteoporosis was evaluated as BMD in T-score by Quantitative bone ultrasound (QUS). Result: Epileptic patient group had significantly lower T-score (−1.02±0.86) compared to controls (−0.47±0.93) (p < 0.001). Thirtythree patients (41.2%) had T-score indicating osteopenia and 4 patients (5%) had T-score which indicated osteoporosis. Osteopenia was demonstrated in 15 male patients (46.9%) and 18 female patients (37.5%) and normal BMD was demonstrated in 14 male patients (43.8%) and 29 female patients (60.4%). T-scores in patients on monopharmacy with phenytoin (−0.85±0.92) were similar to patients taking only valproate (−0.62±0.47) (p = 0.513). Patients on polypharmacy had lower T-score (−1.17±0.88) compared to monopharmacy patients (T-score −0.79±0.80) (p = 0.051). The polypharmacy patient (57.1%) group had significant osteopenia or osteoporosis status more than monopharmacy patient group (29.0%) (p = 0.014). Conclusion: The epileptic patients taking AEDs for more than 1 year had significantly lower BMD compared to controls. The epileptic patient group had osteopenia and osteoporosis status more than controls. Monopharmacy with phenytoin or valproate showed similarily loss of BMD. Polypharmacy patient group had lower T-score and significant osteopenia or osteoporosis status more than monopharmacy patient group. PO18-WE-49 The paradox of epilepsy surgery and psychosis: report of two cases P. Sanguankiat, C. Nabangchang. Division of Neurology, Dept. of Pediatrics, Pramongkutklao Hospital, Bangkok, Thailand New-onset psychosis following epilepsy surgery is rare. We report two distinct cases who developed psychosis after right temporal lobectomy and left frontal lesionectomy plus corpus callostomy respectively. Case summary: The first patient was a 16 years-old female who developed de novo acute psychosis characterized by outbursts behavior, aggression, visual/ auditory hallucination, and delusion one year after right temporal lobectomy. She was subsequently admitted to Pramongkutklao hospital for several weeks. Serial Electroencephalogram revealed neither epileptiform abnormalities nor subclinical seizures. There were no intercurrent illness and optimal investigations did not reveal explainable cause of her psychosis. Her psychosis began during the tapering off period of carbamazepine as she had been seizure-free for 1 year after the surgery. The second case was a 19 years-old male who had mental retardation and medically intractable epilepsy. He underwent left frontal lesionectomy plus corpus callostomy for seizure control. No intraoperative or immediate postoperative complications were noted. Two weeks after the surgery, he developed aggression, behavioral change and insomnia despite dramatic improvement of his epilepsy. He was hospitalized and his psychosis had improved after administration of antipsychotic drugs. There was no history of psychosis in both familial members or in the patients prior to the surgery. After a few months, their psychosis had gradually but

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significantly improved with treatment with antipsychotic drugs as in several case reports of psychosis after epilepsy surgery. Conclusions: We hypothesize that several mechanisms may play important role of this paradox. Further studies will be required to address the link between the two aspects. PO18-WE-50 Treatment of epilepsy in ayurvedic system of medicine V. Dogra1 , M. Sharma1 , A. Sharma1 , S. Kumar Pal2 . 1 Institute of Ayurveda, S D S M Vocational Traning Centre, Una, India; 2 Department of Neurology, Postgradaute Instit. of Medical Education and Res, Chandigarh, India Purpose: To study literature references regarding epilepsy and its treatment in ayurvedic system of medicine prevalent from ancient India. Methods: The study is based on the retrieval of existing literature of Vedas (Rig veda, Sama veda, Yajurveda and Atherva) and cure for the treatment of epilepsy. Results: There are three fundamental systems of the body namely doshas, dhatus and malas. Doshas (humour): Vatta, Kapha and Pitta govern the physiological and physiochemical activities of the body. In Ayurveda, neuro-logical diseases are generally studied under Vatta roga. The ancient ayurvedic medicines used are: 1. Shatavar powder (Asparagus racemosa), 2. Shankhphushpi powder (Convolvulus plauriculus), 3. Nasya-1 (ingradients: Navsadar (Calcium carbonate) + White lime (Ammonium chloride), which are nasal drops. NasyaII: (ingradients: Mulhathi (Glycyrrhiza glabora), Hing (Ferula foetida), Vacha (Acorus calamus), Tagar (Valeriana wallichii), Shirishbeej (Albizzia lebback). Grind and mix with goat’s urine are nasal drops. 4. Lep (Paste): (ingradients: Tulsi (Ocimum sanctum), Kuth (Sassuria lappa), Harad (Terminalia chebula), Jatamansi (Nordostachys jatamansi), Shankpushpi (Convulvus plauricaulis). Grind all the ingredients in the cow’s fresh urine and the person with epilepsy has to apply this paste on entire body. Conclusions: The above medicines are true and authenticated blessings of ancient Indian system of medicine (ayurveda) for the cure of epilepsy which transcends from ancient Indian culture. The inference can also be drawn from the perseverance of our ascetics who prepared promiscuous of herbs from their centuries’ old expertise. All these medicines are brain tonics and increase the function of brain cells, enhance memory, give relaxation to the mind and body and help in cure of epilepsy. Natural system of medicine and cure further derives significance from its being devoid of any side effects as compared with the prevalent practices. PO18-WE-51 Temporal lobe epilepsy surgery: a non invasive presurgical protocol, Moroccan experience F. Lahjouji1 , H. Belaîdi1 , L. Errguig1 , A. Khamlichi2 , M. Jiddane3 , N. Birouk1 , B. Kably1 , R. Ouazzani1 . 1 Neurophysiologie Clinique, Hˆ opital des Sp´ecialit´es, Rabat, Morocco; 2 Neurochirurgie, Hˆ opital des Sp´ecialit´es, Rabat, Morocco; 3 Neuroradiologie, Hˆ opital des Sp´ecialit´es, Rabat, Morocco The Clinical Service of Neurophysiology recruits a great number of patients with intractable temporal lobe epilepsy. These patients are good candidates to surgical treatment. We report our experiment in the non invasive presurgical evaluation based on a confrontation of anatomical and electro-clinical (interictal and ictal) data. On a period of 3 years, seizures of 132 patients were recorded with video-EEG monitoring. On MRI, 56 of them had hippocampal sclerosis (HS) and 35 had mass lesions. Clinical, interictal EEGs and anatomical data were correlated among 51 patients of this group. Monitoring video-EEG confirmed this correlation. Moreover, it was of a great contribution among patients who presented discordance between the anatomical lesion and interictal EEGs (3 patients),

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19th World Congress of Neurology, Poster Abstracts / Journal of the Neurological Sciences 285 S1 (2009) S155–S339

those which had interictal EEGs without abnormalities (9 patients) or with bilateral abnormalities (21 patients). In addition, video-EEG monitoring made it possible to rectify the diagnosis among 48 other patients. This approach allowed us to start our first experiment in term of epilepsy surgical treatment. Thirty five patients (19 with HS and 16 with mass lesion) have been operated with good outcomes in 28 cases. Non satisfying results were mostly obtained in patients with an association of secondary generalized seizures and interictal EEG abnormalities. Currently we try to improve our protocol while waiting for accessibility of invasive investigations in our country. PO18-WE-52 Postoperative prognosis in adult epilepsy patients after functional hemispherotomy or hemispherectomy N. Dericioglu1 , F.I. Tezer1 , K.K. Oguz2 , F. Soylemezoglu3 , A. Ciger1 , N. Akalan4 , S. Saygi1 . 1 Department of Neurology, Hacettepe University School of Medicine, Ankara, Turkey; 2 Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey; 3 Department of Pathology, Hacettepe University School of Medicine, Ankara, Turkey; 4 Department of Neurosurgery, Hacettepe University School of Medicine, Ankara, Turkey Purpose: Hemispherectomy has commonly been performed in pediatric patients who have drug resistant seizures due to widespread severe lesions in a single hemisphere. Frequent postoperative complications have led to the development of new techniques like functional hemispherectomy or hemispherotomy. Few adult patients have been operated with this technique and data regarding postoperative prognosis is scant. Here we report the postoperative results of five patients who have been treated in our epilepsy center and who have been followed up for more than a year. Method: Five patients (4F, 1M, age 16–44, mean: 32.4) underwent functional hemispherotomy (n = 4) or hemispherectomy (n = 1) due to drug resistant seizures at our center between 1999–2007. All patients were hemiparetic and were devoid of fine finger movements. Seizure onset was 12–30 months. On the average all patients had tried 7 different anticonvulsants and had frequent daily seizures. The patients’ interictal/ictal EEG, ictal semiology and cranial MRI data were discussed at a weekly conference where a final consensus was reached. One patient underwent functional hemispherectomy (partial fronto-parietal excision, temporal lobectomy and amygdalo-hippocampectomy), 4 patients had trans-sylvian peri-insular transventricular hemispherotomy and amygdalo-hippocampectomy. Results: The patients have been followed up for 1–9 (mean 3) years. Three patients are seizure free since surgery. One patient had 2 seizure days during the second postoperative month and has been seizure free for a year. The patient who underwent functional hemispherectomy had seizure recurrence during the second postoperative year, however has been seizure free for 7 years since then (80% Engel Class I). All patients are still on anticonvulsant medication. Conclusion: In adult epileptic patients, drug resistant seizures due to widespread severe lesions involving a single hemisphere can be controlled with functional hemispherotomy/hemispherectomy. PO18-WE-53 Effect of temporal lobe epilepsy surgery on cardiovascular autonomic functions M. Tripathi1 , N. Choudhary2 , P.S. Chandra2 , K.K. Deepak2 . 1 Neurology, All India Institute of Medical Sciences, Delhi, India; 2 Physiology, All India Institute of Medical Sciences, Delhi, India Purpose: To measure the prognostic effect of temporal lobe epilepsy surgery on cardiovascular autonomic functions. Methods: Forty five TLE patients, Aged 21.83±11.94were included in this study. All the patients were seizure free and receiving similar antiepileptic drugs during the course of study. For the assessment of

cardiovascular autonomic reactivity, we used a standardized battery of reactivity tests, which includes Deep breathing test, Valsalva maneuver, Isometric exercise test, cold pressor test (CPT) and Head up tilt table tests (HUT). Cardiovascular autonomic activity was measured by short term heart rate variability (HRV). All the tests were conducted before surgery and 3 months and 6 months after the surgery. Results: After surgery TLE Patients showed decrement in Valsalva ¨ Ratio (p = 0.004), ADBP during CPT (p = 0.016), increment in, fall in SBP (p = 0.007) during HUT at 6 months after surgery. Rest of the autonomic reactivity parameters and autonomic tone were comparable at each time points. Conclusion: Our results suggest that TLE surgery reduces the sympathetic reactivity. However parameters of HRV were similar before and after surgery. It seems that there are some factors also in intractable epilepsy patients which reduce the autonomic tone after surgery. So we suggest that TLE surgery reduces sympathetically mediated tachycardia. This may have implications for the the issues involving sympathetic function and epilepsy. PO18-WE-54 Quality of life of epilepsy patients in different antiepileptic treatment E. Trunova, A. Kuznetsov, A. Novik. National Pirogov Centre of Therapy and Surgery, Moscow, Russian Federation Background: Epilepsy is a chronic disease that affects different aspects of life. Quality of life may suffer because the social consequences of epilepsy may include active discrimination in employment, reduced participation in community and civic activities, stigma, problems in family relationships. Purpose: Purpose of this study was the estimation of quality of life of epilepsy patients in different antiepileptic treatment. Material and methods: We studied 96 adults with relatively well controlled partial epilepsy without symptomatic etiology. The patients were treated with valproate (n = 19), carbamazepine (n = 19), levetiracetam (n = 14), lamotrigin (14), topiramat (15) and oxcarazepin (15). We used short form of Russian version of medical questionnaire SF-36, EQ-5D scales to evaluate QoL. Follow-up was 24 weeks. Multiple regression analysis was performed to assess the influence of different therapy on QoL. Results: There were no significant differences between the groups in terms of symptoms or quality-of-life scores after baseline. After 24 weeks of treatment the indicators of six subscales of SF-36 (RE, MH, RP, GH, VT, SF) was significantly greater in the levetiracetam, topiramat, lamotrigin, oxcarazepin group in comparison with the carbamazepin and valproate group (p < 0.05). According to scale EQ-5D indicators of quality of a life were above at patients of levetiracetam, topiramat and oxcarazepin groups. Quality of life was lower in the patients with high frequency adverse effects. In 3.1% of the patients treated with carbamazepine decrease of attention and subjective sensation of drowsiness have been revealed. In 3.1% of the patients treated with valproate had gastroenteric dysfunctions. QoL was not changed significantly in the patients treated with valproate. Conclusion: Epilepsy and reception antiepileptic drugs essentially influence quality of a life. Quality of a life was lower at patients at which there were adverse from antiepileptic therapies.