The risk of PTS was higher in patients who sustained fall from height, in GCS<9, and associated medical problems. About 1/3rd of the patients with early PTS developed recurrent delayed seizures.
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.
This preliminary study demonstrated the efficacy and safety of complete callosotomy with anterior, hippocampal, and posterior commissurotomy in Lennox-Gastaut syndrome (drop attacks) with moderate to severe mental retardation.
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.
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