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: 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.

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.

Background & Objective: Acute ischemic stroke (AIS) has been shown to be effectively treated with thrombolytic therapy. Thailand and other developing countries have limited stroke specialists to prescribe this treatment. Data regarding stroke outcomes in AIS patients who received thrombolytic therapy prescribed by neurologists compared with non-neurologists are limited. Methods: This was a large, multicenter, retrospective study conducted in 9 hospitals across the northeastern part of Thailand. The inclusion criteria were AIS patients who were admitted and treated with thrombolytic therapy between January 2010 and December 2012. Patients were categorized into two groups by physician specialty; neurologist and non-neurologist. Clinical outcomes and in-hospital mortality were compared between the groups. Results: There were 915 AIS patients who participated in the study; 175 patients were treated by the non-neurologists (19.1%). The mean age of all patients was 64 years and 55.1% were men. The median onset to needle time in both groups were similar at 180 minutes. The National Institutes of Health Stroke Scale (NIHSS) at discharge were significantly higher in neurologist group than non-neurologist group (NIHSS 6 vs 3, p value 0.03). The in-hospital mortality was also higher in neurologist group (9.5% vs 4.0%; p value 0.02). Conclusions: Non-neurologists may be able to thrombolyze AIS patients safely and effectively.
Stroke ; Thrombolytic Therapy