The aim is to examine the effects of valproic acid on the metabolic parameters, body composition and anthropometric measurements. Non-obese patients diagnosed with idiopathic epilepsy were included in the study. Multifrequency bioelectrical impedance analysis, anthropometric measurements, fasting glucose, lipid levels, serum insulin levels and thyroid function tests were evaluated at the beginning, third and sixth months of valproic acid treatment. A total of 25 patients were investigated. The mean age of patients was 8.21±3.96 years. The body mass index of patients significantly increased during treatment. Fat mass, lean mass, basal metabolism rate, body fat mass index and fat free mass index values significantly increased and basal metabolism rate/body weight ratio significantly decreased during valproic acid treatment. Significant increase in thyroid stimulating hormone levels and significant decrease in free thyroxine levels occurred during the treatment.Conclusion: valproic acid leads to weight gain by both increasing fat and lean mass.

Motor posturing in acutely comatose patient is suggestive of an evolving brain herniation. In the presence of a unilateral pupillary abnormality, a metabolic or drug induced coma can be excluded. Neuroimaging studies in such cases will likely reveal underlying mass or acute ventricular obstruction. We recently encountered a patient who presented in stupor with repetitive motor posturing and a transient right oval pupil to light stimulus. Surprisingly, an urgent brain CT revealed only mild global atrophy for age. Further evaluation disclosed cryptococcus meningitis as the underlying cause.

Background & Objective: Currentlythere is limitedintervention for acute ischemic stroke. Recombinant tissue plasminogen activator (rTPA) has been approved for immediate recanalization after a steno-occlusive lesion of cerebral vessels. rTPA has shown its efficacy and safety from several clinical trials. The present study reports our experience with intravenous rTPA from several centers in the Philippines.Method:This is a retrospective cohort study consisting of 157 patients who qualified to receive rTPA following the NINDS trial inclusion and exclusion criteria. The primary outcome is in-hospital and 3-months mortality. Other outcome measures were determined: intracranial hemorrhage secondary to hemorrhagic conversion and functional outcome as measured by modified Rankin Scale. Additionally, standard dose (0.9mg/kg) was compared to low dose (0.6mg/kg) of rTPA in terms of mortality, intracranial bleeding and functional outcome.Results:The in-hospital mortality was seen in 23 (14.6%) and total death within 3 months was 18.3%. Independent patient (mRS 0-2) was seen in 69 (51.1%) at discharge and 95 (73.1%) at 3 months. Intracranial bleeding due to asymptomatic hemorrhagic transformation occurred in 39 (24.8%) and symptomatic hemorrhagic transformation was seen in 19 (12.1%).Conclusion: Comparing our results with SITS-MOST and Cochrane collaborations, our data showed that we have more independent patients however death and intracranial bleeding was noted to be high in our cohort of patients. Additionally, the study showed more independent patients in the low dose group.

Background: The HLA-B*15:02 polymorphism in epileptic patients is known to be associated with carbamazepine-induced Stevens-Johnson syndrome (SJS). The prevalence of HLA-B*15:02 polymorphism seemed to be ethnic-specific with a higher frequency of HLA-B*15:02 in Asian compared to the Europeans. This study was performed to determine the frequency of the HLA-B*15:02 polymorphism in epileptic patients at the Chancellor Tuanku Muhriz Hospital-UKM Medical Centre (HCTM-UKMMC) using high resolution melting-real time PCR (HRM-QPCR) method. Methods: We performed a fast and effective in-house high resolution melting-real time polymerase chain reaction method and compared it with the conventional multiplex-PCR method. The specificity and sensitivity of each test were also determined using DNA from saliva. Results: Using the conventional multiplex-PCR approach for screening, 25 out of 64 (39.1%) epileptic patients were positive for HLA-B*15:02. However, using the HRM-QPCR technique, 24/64 (37.5%) of the patients were positive. The one patient who tested positive by the multiplex-PCR but negative using the HRM-QPCR turned out to be negative by DNA sequencing. The HRM-QPCR and DNA sequencing showed 100% sensitivity and specificity. The multiplex-PCR showed 100% sensitivity and 98.4% specificity compared to both HRM-QPCR and DNA sequencing. The HRM-QPCR is also more cost-effective (<$16.40 USD/test) and less time-consuming when compared to the multiplex-PCR ($25.15 USD/test).Conclusion: Our result suggested that multiplex PCR, HRM-QPCR and Sanger sequencing can be used for detection of HLA-B*15:02. However, a qualitative method such as multiplex PCR should be confirmed with other quantitative methods such as HRM-QPCR and Sanger sequencing.

This study described the clinical and paraclinical features of south Indian patients with longitudinally extensive transverse myelitis (LETM) and contrasted the findings betweenaquaporin-4 positive versus negative patients. The subjects were recruited between2010 and 2013.The distinctive features among71 LETM patients were compared and it was observed that 56% of the total subjects were found to be AQP4-Ab positive. The ratio of female tomale was found to be higher in the AQP4-Ab positive group. Magnetic resonance imaging showed holocord involvement more commonly in AQP4-Abnegative than positive group. The presence of hypointense lesions did not correlate with severity. The main distinctive features between AQP4-Abpositive and negative cases include older onset age, higher proportion of female, low frequency of conus involvement and higher prevalence of coexisting autoimmune disorders in AQP4-Ab positive cases. Therewas no difference in attack severity, onset of optic neuritis, and spasms between the two groups. Our results suggest that the clinical and spinal cord neuro-imaging information can aid in distinguishing between the positive and negative group of patients with LETM. The early detection of AQP4-Ab positive status predicts the recurrence of LETM or occurrence of optic neuritis duringthe study period.

Objective:To explore the etiological spectrum of solitary corpus callosum lesions in children. Methods:Retrospective analysis ofclinical features, laboratory findings and brain MRI of 20 children with isolated corpus callosum lesions and treated in Taiyuan, northern China. Results:The average age of onset was 3.64±3.25 years old. The main clinical symptoms were seizures (13 cases, 65%), fever (10 cases, 50%), gastrointestinal symptoms with vomiting or diarrhea (10 cases, 50%), neck stiffness (5 cases, 25%), altered states of consciousness (4 cases, 20%). Brain MRI showed the splenium lesion to be oval in shape. Repeat MRI showed reversal of the lesion after a mean of 29.5 days. Though the patients were suspected to have probable viral encephalitis, no etiology was found in 15 cases. There was associated gastroenteritis in 5 patients, and rotavirus confirmed in stool in 4 patients. Close to half the patients had hyponatremia. None of the patient had had persistent neurobehavioural symptoms on follow-up at 12-14 months. Conclusions:This study from northern China confirmed that isolated solitary corpus callosum lesion is benign

In-stent restenosis occurs in approximately 30% of patients after receiving a Wingspan stent to treat symptomatic intracranial atherosclerosis. This report describes a 55-year-old man with intracranial atherosclerotic internal carotid artery terminus stenosis who developed significant in-stent restenosis. Follow-up angiogram 5 years later demonstrated the regression of restenosis without invasive intervention.

Granulomatous amoebic encephalitis caused by Acanthamoeba is a rare entity mainly affecting immunocompromised patients. We reported a case of Acanthamoeba encephalitis of a 1-year-old immunocompetent child and described the CT and MRI findings of the brain, while reviewing the relevant literatures. The imaging findings of Acanthamoeba meningoencepalitis in immunocompetent patients are non-specific and pose a diagnostic challenge.

Colchicine-induced neuromyopathy is an extremely rare complication, and can develop in the setting of acute overdose or chronic administration in therapeutic doses. A 72-year-old man presented with proximal muscle weakness and myalgia. He had angina pectoris and Behçet’s disease, leading to the treatment of colchicine (1.2 mg daily for about 6 years), cyclosporine, methylprednisolone, simvastatin, and aspirin. A biceps brachii muscle biopsy was performed and electron microscopic examination revealed scattered autophagic vacuoles. He was initially treated with steroid pulse therapy. However, muscle weakness did not improve. After the discontinuation of colchicine, muscle power and myalgia improved steadily. There should be heightened awareness of colchicine-induced neuromyopathy because that clinical suspicion is the most important diagnostic clue, and termination of colchicine is the only treatment.

Polyneuritis cranialis (PNC), a variant of Guillain-Barré syndrome (GBS), is a very rare disorder of multiple cranial nerve palsies without any peripheral nerve involvement or ataxia. While pain is frequent in GBS, headache is not known in the patient with PNC. We report a 72-year-old man who presented acute bilateral multiple cranial neuropathy, including neuropathies of cranial nerve III-XII and severe and prolonged headache. The brain MRI, cerebrospinal fluid examination, and peripheral nerve conduction studies showed no abnormalities. The headache improved in five weeks. All cranial neuropathies resolved completely 8 months later. We suggest that headache should be considered as an additional cardinal feature of PNC along with multiple cranial neuropathies