Background: Oral topiramate is a broad-spectrum antiepileptic drug. There is limited documented data on its use in refractory convulsive and non-convulsive status epilepticus. Methods: A retrospective study of the clinical characteristics and responses of patients diagnosed as status epilepticus treated with topiramate at the Srinagarind Hospital, Khon Kaen University from 2001-2010. Results: There were 8 patients included in this study, 6 patients were convulsive status epilepticus and 2 patients were non-convulsive status epilepticus. The most common cause was stroke seen in 4 patients. Oral topiramate successfully controlled status epilepticus in 7 out of 8 patients with no serious adverse events. Of these 7 patients, status epilepticus was controlled after initial loading and re-loading of oral topiramate in 3 and 4 patients, respectively. In two patients with hepatitis, oral topiramate was successful after failure with benzodiazepine. The initial loading dose of topiramate in most cases was 400 mg with a maintenance dose of 100 mg/day. Conclusion: Oral topiramate has the potential to treat both convulsive and non-convulsive status epilepticus after failing the fi rst antiepileptic drug. Further study with larger number of patients is needed to confi rm this.

Four cases of Guillain-Barré syndrome (GBS) after diphtheria and tetanus vaccine (dT) during diphtheria outbreak in Thailand are reported. Three cases had an age over 60 years, and developed GBS after the second dose of dT vaccine. Two cases received intravenous immunoglobulin and had improvement after treatment. The autoantibodies or anti-ganglioside antibodies are believed to be the possible explanation of GBS associated with vaccination. Data regarding post-dT vaccine GBS are limited in Asian populations particularly on clinical presentation and outcomes.

Background: Seizure is a common neurological presenting symptom at the emergency department (ED). Recurrent seizure may result in an overcrowded ED and affect morbidity. Factors associated with recurrent seizure in Thailand or other developing countries are limited. Methods: Clinical features of adult patients who presented with seizure at the ED, Ramathibodi Hospital, Mahidol University, Thailand were retrospectively reviewed. Factors associated with recurrent seizure were identified by multivariate logistic regression analysis. Results: During the study period, there were 65,586 patients who visited the ED. Of those, there were 156 seizure patients who were identified for analysis. The mean (S.D.) age of all patients was 47.44 (19.80) and males accounted for 41.67%. There were 40 patients who had recurrent seizures (25.64%). There were 10 significant factors associated with recurrent seizure at the ED. Of those, seven factors had a positive association with recurrent seizure; the top three factors were seizure attacks >4 times prior to ED visit, age >70 years and cerebral infarction, while the other three factors were negatively associated (history of antiepileptic drugs, brain surgery and alcohol consumption). Conclusions: Recurrent seizure at the ED may be related to seizure history prior to the ED visit, age, cause of seizure, and co-morbid conditions.
Seizures

Background: Epilepsy is a common disease but to achieve successful seizure control in developing countries is still a challenge. This study aimed to investigate the epilepsy services in Thailand. Methods: This was a survey by questionnaires on epilepsy service sent to 1,033 public hospitals all over Thailand. Results: The response rate was 54.1%. The results show that most of physicians that provide care for persons with epilepsy were General Practitioners (91.5%). Epileptologists and Neurologists accounted for only 11.1% and 14.4%. There were only 52 EEG, 54 CT Scan, and 6 MRI instruments in the entire country of 65 million. Standard antiepileptic drugs (AEDs) were widely available, phenobarbital (99.9%), phenytoin (96.0%), carbamazepine (97.9%), and valproic acid (89%) of institutions. The availability of new AEDs were: gabapentin (77.6%), topiramate (63.9%), levetiracetam (46.0%), lamotrigine (45.3%), pregabalin (33.6%), were also available in 77.6%, 63.9%, 46.0%, 45.3%, 33.6%, vigabatrin (14.5%), and oxcarbazepine (14.3%) of institutions. Intravenous AEDs used for status epilepticus patients include phenytoin (54.2%), phenobarbital (33.9%), and sodium valproate (12.1%). Therapeutic drug monitoring could be done in 45.7% of the responding hospitals. Conclusion: There is limited human and material resources for the care of epilepsy in Thailand. There is a need to develop a model of epilepsy care that is appropriate with the limited resources in the country.

Isolated acute bulbar palsy has been described as one of the more rare variants of Guillain-Barré syndrome. IgG anti-ganglioside antibodies are associated with axonal subtypes of Guillain-Barré syndrome as well as Fisher syndrome. However, IgG against GM3 and GT1b in relation to bulbar palsy is uncommon. In this case report, we describe a 64 year-old male patient presenting with isolated bulbar weakness and generalized hyporeflexia without limb weakness. Serological testing for antiganglioside antibodies was positive for IgG anti-GM3 and -GT1b, suggesting the association of these antibodies with isolated bulbar palsy.

BACKGROUND:In emergency conditions, the actual weight of infants and young children are essential for treatments. The RAMATHIBODI Pediatric Emergency Drug Card or RAMA Ped Card has also been developed to estimate actual weight of the subjects. This study aimed to validate the RAMA Ped Card in correctly identifying the actual weight of infants and young adults. METHODS:This study was a prospective study. We enrolled all consecutive patients under 15 years of age who visited the emergency department (ED). All eligible patients' actual weight and height were measured at the screening point of the ED. The weight of each patient was also measured using the unlabeled RAMA Ped Card. The Cohen's kappa values and agreement percentages were calculated. RESULTS:During the study period, there were 345 eligible patients. The RAMA Ped Card had a 61.16％ agreement with the actual weight with a kappa of 0.54 (P<0.01), while the agreement with the actual height had a kappa of 0.90 and 91.59％ agreement. Sub-group analysis found kappa scores with good range in two categories:in cases of accidents and in the infant group (kappa of 0.68 and 0.65, respectively). CONCLUSION:The RAMA Ped Card had a fair correlation with the actual weight in child patients presenting at the ED. Weight estimation in infant patients and children who presented with accidents were more accurate.

INTRODUCTIONBrugada syndrome (BrS) is a common genetic cause of sudden cardiac arrest (SCA) due to polymorphic ventricular tachycardia and ventricular fibrillation. The current recommended therapy for high-risk BrS patients is the use of an implantable cardioverter defibrillator (ICD). The present study aimed to report the clinical characteristics and treatment outcomes of BrS patients in northeastern Thailand.

METHODSPatients who were diagnosed with BrS or had a Brugada electrocardiogram (ECG) between 2005 and 2012 at Khon Kaen University's hospitals were enrolled in the present study. Patients' clinical characteristics, ECG type, laboratory results and treatment were reviewed.

RESULTSA total of 90 eligible patients were enrolled. Of these, 79 (87.8%) patients were symptomatic--65 (82.3%) had documented SCA and 14 (17.7%) had unexplained syncope. The remaining 11 (12.2%) patients were asymptomatic with Brugada ECG. A majority of the patients enrolled were born in northeastern Thailand. The mean age of the symptomatic patients was 44.49 ± 8.55 years. Among the symptomatic patients, a majority were male (n = 77, 97.5%) and 23 (29.1%) patients had a family history of SCA. Almost all BrS patients who were symptomatic (96.2%) received ICD treatment for secondary prevention. The number of patients who received appropriate ICD therapy was 4.2 times of those who received inappropriate shocks. Only 3 (3.8%) symptomatic BrS patients refused ICD treatment.

CONCLUSIONClinical characteristics did not distinguish between symptomatic BrS patients and asymptomatic patients with Brugada ECGs. The clinical characteristics and treatment outcomes for the symptomatic BrS patients with SCA and unexplained syncope were similar. Among the BrS patients implanted with secondary prevention ICD in Northeastern Thailand, nearly one-third had received appropriate ICD therapy, far exceeding the incidence of device-related complications and inappropriate therapy.

Adult ; Brugada Syndrome ; diagnosis ; therapy ; Death, Sudden, Cardiac ; prevention & control ; Defibrillators, Implantable ; Electrocardiography ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Secondary Prevention ; Syncope ; therapy ; Tachycardia, Ventricular ; prevention & control ; Thailand ; Ventricular Fibrillation ; prevention & control

INTRODUCTION: Both myasthenia gravis (MG) and autoimmune thyroid diseases (AITDs) are autoimmune diseases. Graves'disease (GD) is the most common AITD reported to be associated with MG. Currently, there is limited data on prevalence and clinical features/outcomes of MG in various thyroid diseases in a large database report.

METHODOLOGY: A total of 872 patients with MG and 97,251 patients with thyroid disorders had been recorded by the tertiary hospital database. The study period was between 1997 and 2017. Patients with a thyroid disorder and MG were identified by the ICD-10-CM code. Clinical courses of MG accompanied by thyroid disorders were studied.

RESULTS: During the 20-year study period, there were 872 patients with MG and 97,251 patients with thyroid disorders. In the group with thyroid disorders, 28,886 patients (29.70%) had GD, 1,612 patients (1.66%) had Hashimoto's thyroiditis, 13,172 patients (13.54%) had toxic goiter and 53,581 patients (55.10%) had nontoxic goiter. 97 patients had been diagnosed with both MG and thyroid disorders. Among the four types of thyroid disorders, the rate of MG was highest in HT group (9.92/1,000 HT patients). There were four significant factors among four groups of thyroid disorders including age of onset of thyroid disease (p 0.004), MG classification (ppp 0.034). Among the four groups of thyroid disorders, patients with MG and HT were diagnosed with thyroid disease at the youngest age (27 years) compared with other thyroid diseases. Additionally, the MG patients with HT also had the highest proportion of MG class 4-5 a/b (7 patients, 43.75%), received prednisolone treatment (15 patients, 93.75%), received immunosuppressants (9 patients, 56.25%), received IVIG or PLEX (5 patients, 31.30%), and had thymoma (6 patients, 46.15%).

CONCLUSION: MG is most prevalent in patients with HT. Patients with both MG and HT had more severe MG status and had higher rate of thymoma.

Human ; Prevalence

Objective To find additional factors suggestive of hepatitis C virus (HCV) infection in the general population by using data from a hepatitis virus survey. Methods This study collected data of HCV infection from a hepatitis virus survey. The survey was conducted in 13 provinces in the northeast Thailand in 2014 and 2015. During the survey, a blood test was performed to screen for HCV. A questionnaire was also distributed to all participants asking about baseline characteristics, risk factors for HCV infection, and daily life activities. Risk factors for HCV infection were executed. Results There were 2 112 participants for the survey. Of those, 110 participants (5.21%) tested positive for HCV infection. After adjustment by multivariate logistic regression, three factors were significantly associated with HCV infection, namely male gender, age, and family history of liver cancer. The adjusted ORs and 95% CI of these factors were 3.14 (1.50, 6.56), 3.78 (1.12, 12.76), and 2.28 (1.08, 4.80), respectively. Conclusions Male gender, increasing age, and family history of liver cancer are predictors of HCV infection in endemic areas. Males with a family history of liver cancer in their first-degree relatives should be tested for HCV infection regardless of symptoms.

Eosinophilic meningitis, caused by the nematode Angiostrongylus cantonensis, is prevalent in northeastern Thailand, most commonly in adults. Data regarding clinical manifestations of this condition in children is limited and may be different those in adults. A chart review was done on 19 eosinophilic meningitis patients aged less than 15 years in Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. Clinical manifestations and outcomes were reported using descriptive statistics. All patients had presented with severe headache. Most patients were males, had fever, nausea or vomiting, stiffness of the neck, and a history of snail ingestion. Six patients had papilledema or cranial nerve palsies. It was shown that the clinical manifestations of eosinophilic meningitis due to A. cantonensis in children are different from those in adult patients. Fever, nausea, vomiting, hepatomegaly, neck stiffness, and cranial nerve palsies were all more common in children than in adults.
Adolescent ; Adult ; Aged ; Angiostrongylus cantonensis/*isolation & purification ; Animals ; Child ; Child, Preschool ; Eosinophilia/complications/etiology/*pathology ; Female ; Humans ; Male ; Meningitis/complications/etiology/*pathology ; Middle Aged ; Patient Outcome Assessment ; Strongylida Infections/parasitology/*pathology ; Thailand ; Young Adult