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Background: Psychogenic movement disorders (PMD) is a group of disorders that cannot be attributed to any structural or biochemical abnormality, but has an underlying psychiatric illness. The profile of PMD varies according to country and socioeconomic factors. Methods: The present study reports the clinical profile of patients with PMD from India. Seventy-three patients with documented or clinically established PMD were seen over a period of 14 years with detailed neurological and psychiatric examinations. Results: The mean age at presentation was 29.1 ± 15.1 years (women, 51%). Approximately 30% were ≤18 years of age (boys, 63.6%). The onset of symptoms was abrupt in 61.6% and the initial body part most often affected was right upper limb (adults, 29.4%; children, 31.8%). Tremor was observed in 31.4% of adults and 9% of children, whereas myoclonus was more common in children (36.4%). Tremors were more often seen in women (42.3%) than in men (20%), whereas myoclonus was almost equally prevalent in girls (37.5%) and boys (35.7%). Depression was the most common psychiatric comorbidity (men, 16%; women, 15.4%). About 42.5% required hospital admission and 57.5% had significant reduction or complete cessation of PMD after counseling, antidepressants, and/ or placebo. Conclusions: PMD was equally prevalent among women and men. Tremor was most often observed in adults, whereas myoclonus was most often observed in children. Electrophysiology and placebo were useful supplementary tools for diagnosing PMD.RÉSUMÉ: Déterminants des sujets présentant des troubles psychogènes du mouvement selon le sexe et l'âge: profil clinique de 73 patients. Contexte: Les troubles psychogènes du mouvement (TPM) constituent un groupe de problèmes de santé qui ne peuvent être attribués à aucune anomalie structurale ou biochimique et qui sont dus à une maladie psychiatrique sous-jacente. Le profil des TPM varie selon le pays et les facteurs socio-économiques des patients. Méthode: Nous rapportons le profil de patients présentant des TPM en Inde. Soixante-treize patients présentant des TPM documentés ou établis cliniquement ont subi des examens neurologiques et psychiatriques détaillés au cours d'une période de 14 ans. Résultats: L'âge moyen des patients au moment de la consultation initiale était de 29,1 ± 15.1 ans et 51% étaient des femmes. À peu près 30% étaient âgés de 18 ans ou moins et parmi eux, 63,6% étaient des garçons. Le début des symptômes avait été soudain chez 61,6% et la partie du corps initialement touchée était le plus souvent le membre supérieur droit (29,4% chez les adultes, 31,8% chez les enfants). Chez les adultes, 31,4% avaient du tremblement ainsi que 9% des enfants. La myoclonie était plus fréquente chez les enfants (36,4%). Les tremblements étaient plus fréquemment observés chez les femmes (42,3%) que chez les hommes (20%). La myoclonie était presqu'aussi fréquente chez les filles (37,5%) que chez les garçons (35,7%). La dépression était la comorbidité psychiatrique la plus fréquente tant chez les hommes (16%...

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Epilepsy treatment is challenging because of multiple impediments like lack of efficacy of monotherapy, adverse drug reactions, and different comorbidities. Add-on therapy to first-line antiepileptics may be the option to overcome therapeutic hurdles. The present randomized, double-blind, add-on placebo-controlled clinical trial was conducted to evaluate the effect of add-on melatonin in the treatment of generalized epilepsy with generalized onset motor seizure in adults. The control group (n = 52) received add-on placebo, and the test group (n = 52) received add-on melatonin (3 mg/day) with valproate (20 mg/kg in two divided doses). Clinical evaluation of seizure frequency, Chalfont-National Hospital seizure severity scale (NHS3), Pittsburgh sleep quality index (PSQI), quality of life in epilepsy inventory, Epworth sleepiness scale (ESS), and biochemical estimation of serum neuron-specific enolase (NSE) and glutathione reductase were done at baseline and compared with follow-up at 8 weeks. Among 104 patients randomized [mean (SD) age of 27.6 (11.5); 84 (80.8%) male], 88 (84.6%) completed the trial. The responder rate and seizure-free rate in the test group were significantly (p = 0.006 and 0.034) higher than the control group.There was a significantly higher reduction in the frequency of seizures (p = 0.016) and NHS3 (−2.39; 95%CI: −4.56 to −0.21; p = 0.032) in the test group compared to the control group. Similarly, improvement in PSQI (−1.40; 95%CI: −2.64 to −0.15; p = 0.029) was significantly better in the test group. There was no significant difference in the change in ESS (p = 0.621) and quality of life scoring (p = 0.456) between the study groups. The decrease in serum NSE was significantly higher with the test group compared to the control group (−2.01; 95% CI: −3.74 to −0.27; p = 0.024).Add-on melatonin increased serum glutathione reductase significantly (p = 0.038), but there was no significant difference between the groups (p = 0.685). Add-on melatonin with valproate for generalized epilepsy with generalized onset motor seizures | 1619 VERMA Et Al. 1 | INTRODUC TI ON Epilepsy is a chronic disabling disorder with neurobiological, cognitive, psychological, and social comorbidities leading to impaired quality of life (Yogarajah & Mula, 2019). Despite the abundance of antiepileptic drugs (AEDs), even after long-term treatment of 6-8 years, 30% of patients continue having seizures (Brigo et al. 2016). Treatment with valproate for generalized epilepsy is associated with weight gain, gastrointestinal distress, alopecia, dizziness, depression, idiosyncratic toxicities like hepatotoxicity, pancreatitis, thrombocytopenia etc. and hence, therapeutic drug monitoring is required to prevent dose-related toxicities. Moreover, comorbidities like sleep disorders, cognitive impairment, anxiety disorders, and depression make the treatment challenging. Sleep disorders in patients with epilepsy are prevalent, and previous studies proved that seizure and sleep are reciprocally related (Ekizoglu et al. 2011). Sleep architect...

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