This study provides Class I evidence that the number of stable epilepsy patients who have breakthrough seizures and the total number of breakthrough seizures remain the same irrespective of whether patients are reviewed telephonically or face-to-face in the clinic. Clinicians managing epilepsy patients should consider using telephonic review for selected patients. Telephonic reviews have the potential of effectively reducing the secondary treatment gap in millions of patients who do not have easy access to doctors.

The study was done to identify the predictors of refractory epilepsy in the North Indian population attending a tertiary care centre. This case-control study from August 2006 to December 2008 enrolled 200 consecutive patients of intractable epilepsy and 200 age matched controls with well controlled epilepsy. The factors which were significant in univariate analysis were age of onset before fourteen years (OR 7.92), partial seizures (OR 6.27), presence of neurological deficits (OR 19.68), perinatal insult (OR 11.00), delayed milestones (OR 13.93), history of CNS infection (OR 7.45), febrile seizures (4.33), high initial seizure frequency of more than one per month (OR 14.26), non response to first Anti Epileptic Drug (AED) (OR 6.71) and abnormal brain imaging (OR 20.47). On multivariate analysis significant predictors were radiological evidence of structural cerebral abnormality (OR 20.47), non response to first AED (OR 19.21), delayed mile stones (OR 9.09), high initial seizure frequency of more than one per month (OR 6.71), partial seizure type (OR 6.27), febrile seizures (OR 5.66) and age of onset before fourteen years (OR 3.09). It is thus possible to identify a certain profile of patients with epilepsy who are likely to be refractory to medical therapy. These observations would be useful in selecting patients early for evaluation in Northern India where a high surgical treatment gap exists.

Study Objectives: Obstructive sleep apnea (OSA) is an independent risk factor for stroke. The objective of this study was to assess the effect of continuous positive airway pressure (CPAP) treatment on prevention of new vascular events among patients with stroke and OSA. Methods: Consecutive conscious patients presenting with first imaging-confirmed arterial stroke were included, 6 weeks or more after ictus. All patients underwent clinical and polysomnography (PSG) testing. Patients with an apnea-hypopnea index (AHI) of > 15 events/h were randomized to posttitration nightly CPAP treatment and non-CPAP (received best medical treatment) groups. On follow-up at 3, 6, and 12 months from randomization, evaluation was carried out for any new vascular events as the primary outcome measure, and for clinical stroke outcomes (using the Barthel Index and modified Rankin scale) and neuropsychological parameters as the secondary outcome measures. Results: Among the 679 patients with stroke who were screened, 116 reported for PSG, 83 had AHI > 15 events/h, and 70 (34 in CPAP and 36 in non-CPAP) were randomized. Thirteen patients could not be randomized because of a lack of CPAP devices. Four patients crossed over from the CPAP to the non-CPAP group. Age (mean age 53.41 ± 9.85 in CPAP versus 52.69 ± 13.23 years in non-CPAP, P = .81) and sex distribution (24 males in CPAP versus 33 males in non-CPAP, P = .79) were similar in both groups. At 12-month follow-up, there was 1 vascular event (3.33%) in the CPAP group and 6 events (15%) in the non-CPAP group (P = .23). Modified Rankin scale score improvement by ≥ 1 at 12-month follow-up was found in significantly more patients in the CPAP group than in the non-CPAP group (53% versus 27%). I NTRO DUCTI O NStroke is common, the second leading cause of death and disability, and is the cause of high health care costs.1,2 Important risk factors for stroke are hypertension, atrial fibrillation, diabetes, and smoking. These are well-established intervention targets for stroke's primary and secondary prevention. that leads to oxygen desaturation and sleep fragmentation. This further leads to an increased risk of cardiovascular disease, stroke, and death. [4][5][6] It has been established that OSA is an independent risk factor for stroke 1,7 and also aggravates other risk factors (hypertension, coronary artery disease, diabetes, and atrial fibrillation).1 The prevalence of OSA among patients with stroke is around 50% to 80%. Even with neurological improvement in patients with stroke, their OSA does not remit or improve. [8][9][10] The high prevalence of OSA among patients with stroke is associated with an unfavorable clinical course in terms of early neurological worsening, delirium, BRIEF SUMMARY Current Knowledge/Study Rationale: Stroke is a common cause of death and disability and obstructive sleep apnea (OSA) is an independent risk factor for stroke. The objective of this study was to assess the effect of continuous positive airway pressure (CPAP) treatment in prevention of new vascular ...

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RSE can be controlled with intravenous loading and maintenance of valproate or levetiracetam which do not cause respiratory depression, hypotension, need of intubation and ICU care. These must always be considered in a developing country scenario where ICU facilities are not always available or while transporting to centres where these facilities are available.