Background & Objective: Helicobacter pylori infection has been associated with extradigestive diseases including epilepsy. The main aim of the study was to determine the prevalence of Helicobacter pylori using 13C urea breath test (UBT) in epilepsy patients in a teaching hospital in Malaysia and compared to control. Methods: The study subjects were epilepsy patients from the neurology clinic in a teaching hospital. The study was conducted from August 2010 to February 2011. The control consisted of healthy individuals matched for age and gender, not on any acid suppression medications and antibiotics. All subjects underwent UBT as per protocol. Variables such as age, race, household income, types of epilepsy, duration of epilepsy, number of antiepileptic drugs, prognosis were analysed. Good prognosis was defi ned as seizure free for 3 years. Results: Forty eight epilepsy patients and 47 control subjects were studied. Prevalence of H. pylori infection in the epilepsy patients was 37.5% (n=18) and was 36.2% (n=17) in control. There were signifi cantly more subjects in the epilepsy group with lower income. There were also more smokers in the epilepsy group but there was no association between smoking and positive UBT. Epilepsy patients with poor prognosis have a higher UBT positive rate compared to the good prognosis group (64.3% vs 35.7 %). However the difference was not statistically signifi cant. Conclusion: The prevalence of H. pylori infection in epilepsy patients is similar to that of the control in this study involving Malaysian subjects.

Madam S, who diagnosed to have stage IV lung adenocarcinoma with exon 21 L858R point mutation (T3N2M1a) was admitted for massive pericardial effusion in April 2016. She was ECOG 4 on admission. Her ECOG improved to 1 after pericardial tapping and initiation of free sample erlotinib 100 mg daily. Repeated CT thorax post treatment showed the disease was partial responded. Due to financial constraints, she had never bought any EGFR-TKI. She was given a free sample of erlotinib intermittently for total of 12 months followed by intermittent afatinib supply for 2 years. Due to this limited supply, she took half doses of afatinib by cutting a 40 mg tablet once every few days to sustain the continuation of cancer treatment. No major side effects were observed and she remained ECOG 0 with good weight gain. Up to her last clinic visit in September 2021, her PFS was more than 5 years. Intermittent doses of EGFR-TKI may prolong PFS in patients with advanced EGFRm+ NSCLC who has limited treatment options.