Background Stroke in young person is less frequent than in older populations but has a major impact on the productive individuals and society. Objective To determining risk factors and etiological subtypes of cerebral infarctions in patients of young (20-49 years) age who were admitted to the First Central hospital in Ulaanbaatar, Mongolia. Methods This paper is based on a review of hospital-based studies of patients with cerebral infarction in age range 20-49 years which was conducted from 2009 to 2013. Data regarding onset of cerebral infarction, clinical manifestations, diagnostic test results of patients were examined during their hospital treatment and modified Rankin Scale scores at discharge. Subtyping of cerebral infarction was conducted in accordance with the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Results Out of total number of 1289 patients admitted for cerebral infarctions, 259 (20.1%) were in the 20-49 year age range and the male-to-female ratio was 1.3:1. The most common conventional risk factors were hypertension (39.8%), premature atherosclerosis (20.8%) and dyslipidemia (17.8%). From the rare specific risk factors in young patients with cerebral infarction were migraine with aura in combination with other risk factors and hypotension, and cerebral vasculopathies. The majority of subtype of cerebral infarction was undetermined (34.7%), followed by other determined etiologies (19.7%). Among the category of undetermined etiology, incomplete evaluation (71.1%) was predominant. Most of the patients demonstrated good functional outcomes, at the time of hospital discharge, 86.9% patients had Rankin Scale scores in the range of 0-2 points. Conclusions Young adults with cerebral infarction account for 20.1% of all stroke patients in tertiary referral hospital in Ulaanbaatar. Risk factors, including conventional and specific causes in combination relatively prevalent in young adults, and a high rate of the patients are categorized under conventional, other determined and undetermined etiologies. Cerebral infarction in the young requires a different approach to investigation and management than ischemic stroke in the elderly given differences in the relative frequencies of possible underlying causes. The results show the needs for persistent management of conventional risk factors and properly patient investigation to determine etiology of cerebral infarction in young patients in Mongolia.

Introduction. Traumatic brain injury (TBI) account for 20% of the symptomatic epilepsies in general population. Post traumatic epilepsy (PTE) may be presented with various clinical manifestations of seizure and clinical course of illness varies as well. The incidence of PTE varies with the time period after injury and the population age range under study, as well as the spectrum of severity of the inciting injuries ranges from 4% to 53%. In this study, we aimed to describe clinical characteristics and course of illness of patients with PTE.Materials and Methods. This hospital-based descriptive study was done 2012-2013 in Ulaanbaatar city. We retrospectively obtained number of patients with PTE reported in 2011-2012 from statistical reports of the National Health Center. In this study 109 patients with PTE, aged 16-72 were involved wrom which we collected detailed information on socio-demographic characteristics, history of illness, clinical manifestations including features of seizure and course of illness through pre-developed questionnaire. Medical examination was conducted after the interview to evaluate the seizures in accordance with semiological classification of epileptic seizures and the international classification International Leaque Against Epilepsy. Frequencies of variables including socio-demographic, clinical characteristics and clinical manifestations and, association between type of TBI and clinical manifestations were calculated. Correlation between diagnostic tests and clinical outcomes were also tested. Statistical analysis was conducted using SPSS 17.0 program. Ethical approval was obtained from the Ethical Committee of the School of Medicine, HSUM. Each participant had signed a consent form before involving in the study.Results. 81 (74.3%) participants of 109 were men and 28 (25.3%) were woman. Off our study participants, 98 (90%) were sufferng from generalized tonic clonic seizures. Off all participants, 43 (53.1%) males and 14 (50%) females presented moderate TBI. The mean duration of PTE is 9.6+-9.3 years, participants suffer from PTE 0-5 year. Of all, 19 (23.5%) males have a seizure once a week, 9(32.1%) female have seizure once a month. There were some differences in the forms of brain injury depending from gender; 57(70.4%) of males and 19(67.9%) of females had brain contusion. Only 5 (6.3%) of males had brain concussion, whereas for 6 (22.2%) females had this symptom. For males, intracranial hematoma accounted in 14 (17.7%), but for females in 2 (7.4%). Significant association was observed between clinical form of TBI and duration of loss of consciousness after the injury and injury severity (p<0.002). Of all, 21(19.3%) patients who had TBI were treated surgically. Its occurrence was positively correlated with early onset seizures (P<0.05). The frequency of seizure was not correlated with the structural brain abnormalities, but there was inverse association between frequency of seizure and duration of PTE (r= -0.32, p<0.001). As PTE continues longer the frequency of seizures decreases. Conclusion: Patients particularly surgically treated are suffer from PTE which is presented by generalized seizure. Patients with brain contusion, compression seem to be prone to post traumatic epilepsy. The course of PTE characterized long duration with high frequency of seizure, short time following by severe brain injury.

Background. There are varieties of supports from Mongolian government and health organizations to people with epilepsy. However, epileptics are often socially discriminated due to the negative public attitudes, misconceptions, false beliefs and wrong decisions. Because of this they miss out their right to study or work. Under the aim of providing right information and knowledge about epilepsy to public, carrying out continuous health educational trainings and studies among population is very important to reduce negative attitude towards epilepsy, to prevent from epilepsy stigma and to improve patients’ quality of life.Goal. The objective of this study was to assess the understanding, knowledge and attitude towards epilepsy among population in Ulaanbaatar and to determine some influencing factors.Methods. Questionnaire was carried out within randomly selected 700 people from 6 districts in Ulaanbaatar city.Results. Participants’ age range was from 16 to 64 years and average age was 36.0 (SD 9.34). 64.1% (449) participants out of all had some understanding and knowledge about epilepsy while they possess high school and university educational degree. 42.2% (295) participants had some knowledge about causes of epilepsy, how to react and how to give a first aid for epilepsy patients. However, 57.8% (405) participant out of all involved in the study had not enough knowledge about epilepsy. 29.7% (208) participant had a positive attitude towards epilepsy.ConclusionPersonal age, educational level, information accessed and interaction with people with epilepsy influences to the knowledge about epilepsy.

Background Ischemic stroke or cerebral infarction in young adults (20-50 years) is relatively frequent, accounting for more than 10%-26% of all first strokes and its incidence rises steeply with age. Causes of “Young stroke” are heterogeneous and while it generally has a good prognosis, it has a significant socioeconomic impact, including functional deficits and financial costs. The most frequent causes of cerebral infarction in young adults are cardio-embolism, hypertension, premature atherosclerosis, migraine, smoking and hypercoagulable states. Objective The aim of this study was to compare characteristics of cerebral infarction between young (20-49 years) and old (50-89 years) patients undergoing investigations and treatment according to one common protocol in the tertiary hospital. Methods This Descriptive case series study was conducted in Department of Neurology of First State Central Hospital from October 2014 to July 2016. During this study, we observed 220 patients with first-onset of cerebral infarction from which 90 young patients (under 50 years) and 130 old one (above 50 years), based on prospective study. Data regarding the etiology and risk factors of the stroke, clinical manifestations, and diagnostic test results of patients were examined during their hospital treatment as well as a NIHSS, modified Rankin Scale scores, and Barthel Index at admission and discharge, also at 21 day. Stroke subtyping was conducted in accordance with the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Results In total, 220 patients with cerebral infarction were included, from which 90 (40.9%) were 20-50 years and 130 (59.1%) were 50-89 years. The proportion of males was higher among both groups: 61.1% vs. 70.0%. Common causes for cerebral infarction in the young patients were current smoking (53.3.1% vs. 37.8%), long-term alcohol consumption (51.1 vs. 12.3), cardiac embolism (36.0% vs. 16.2%), migraine with aura (25.5% vs. 12.2%), infective diseases (15.6% vs. 0.8%), and oral contraceptive use (14.4 vs. 0%). Leading causes for ischemic stroke in old patients were the conventional risk factors such as hypertension (75.4% vs. 38.9%), atherosclerosis (66.9% vs. 31.1), coronary artery disease (24.3% vs. 12%), and diabetes mellitus (26.9% vs. 6.7%). Most of the young stroke patients demonstrated good functional outcomes, at the time of discharge (71.1% vs. 60%) and three weeks (86.6% vs. 66.2%) patients had Rankin Scale scores in the range of 0-2. Conclusions There are significant differences between young and old patients with cerebral infarction regarding to risk factors, etiological subtypes and improvement of functional deficits associated with the stroke. However, severity of stroke on admittance is similar but three weeks outcome is different among young and old patients with relatively rapid improvement of functional deficit in young stroke patients than old one.

BACKGROUND: Epilepsy is a common neurological disease, which need to health care and public health servicetopicality that is a very important for people with epilepsy (PWE). Therefore psychosocial problemssuch as depression, anxiety, and stigma, discrimination from other people, negative public attitude andmisunderstanding significantly influence on their psychosocial well-being and quality of life. PURPOSE: To study an anxiety and depression in people with epilepsy.MATERIALS AND METHODS: 77 patients aged between 20 and 60 were included in our study group. In order to identify psychosocial problems we used the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI) and a tenitem measure of felt stigma (Austin, Dunn et al) for this cross-sectional study.RESULT: There were 77 PWE and slightly more 53.2% male, 46.8% female and, in comparison group. Of theseparticipants 44.2%were married, 75.3% unemployment. The frequencies of anxiety symptoms in PWEwere 31.2% very anxiety, 32.5%anxiety and 36.4% not anxiety, the rates of depressive symptoms inPWE were18.2% very depressed, 19.5% depressed and 62.3% not depressed, respectively. All ofthe 62.3% PWE felt stigma. Considering the age, psychological problem, some of the variables ofthe participants, the age of the people with epilepsy was associated with depression and the stigmascores, negatively (r = -0.2, p = 0.05; r = -0.2, p = 0.05).We observed a positive correlation between BDI and BAI scores in PWE (r = 0.6; p = 0.01).There hasalso the relationship between stigma and anxiety, depression, social-interaction of the attitude scoresin PWE (r = 0.5, p = 0.01; r = 0.5, p = 0.01; r = 0.4, p = 0.01), whereas that the correlation statistic didnot indicate a relationship between the duration of the epilepsy and anxiety, depression, stigma andsocial-interaction’s scoresCONCLUSION: Of the people with epilepsy 31.2% have very anxiety, 33.8% have anxiety and 18.2% have verydepressed, 19.5% have depressed. This reveals that it has positive relationship with social-interactionand attitude. Frequency of epileptic seizures influences the anxiety and depression of the people withepilepsy and thus worsens their stigmatization.

Many studies have demonstrated psychosocial problem of people with epilepsy that who has depressionand anxiety symptoms, ashamed, worried, guilt or feelings of worthlessness, poor self-esteem and socialside which includes education, employment issues, marriage, pregnancy, quality of life and stigma. Theseare related to the knowledge of the social, duration of epilepsy and seizure types.People with epilepsy are coexisting that seizure relatedissues such as behavioral and psychosocialproblems and comorbid psychiatric disorders that are prone to develop in patients with this disorder.Therefore hidden psychosocial problems stigmatizing and negative attitude are arisen from the social.The reason of that is demanded improve the quality of life for people with epilepsy and also is requiredto solve problem, completely. Not only medicine is treatment of people with epilepsy, but coping withepilepsy may also associate with psychosocial problemsfacing patients with epilepsy.According to this, hospital and social positive factors need to initiate for the people with epilepsywithout seizure and help to live normally. Furthermore, it is necessary to establish national program andrecommendation.

Complete seizure control is the single most important determinant of good quality of life for patients with epilepsy and the chronic nature of the disorder requires that antiepileptic drugs (AEDs) be administered for many years, often for a lifetime. Therefore, long-term experience is of particular importance in evaluating the efficacy and safety of an AED. Valproic acid increases γ-aminobutyric acid (GABA) synthesis and release and potentiates GABAergic transmission in specific brain regions and it also has also been found to reduce the release of the excitatory amino acid β-hydroxybutyric acid and to attenuate neuronal excitation mediated by activation of N-methyl-D-aspartate (NMDA) glutamate receptors. In addition to these effects, valproic acid exerts direct actions on excitable membranes, including blockade of voltage-dependent sodium channels. Valproate is generally regarded as a first-choice agent for most forms of idiopathic and symptomatic generalised epilepsies. Many of these syndromes are associated with multiple seizure types, including tonic-clonic, myoclonic and absence seizures, and prescription of a broad-spectrum drug such as valproate has clear advantages in this situation. The elimination half-life is in the order of 9 to 18 hours, but shorter values (5 to 12 hours) are observed in patients comedicated with enzymeinducing agents such as phenytoin, carbamazepine and barbiturates. The most commonly reported adverse effects of valproate include gastrointestinal disturbances, tremor and bodyweight gain. Other notable adverse effects include encephalopathy symptoms (at times associated with hyperammonaemia), platelet disorders, pancreatitis, liver toxicity and teratogenicity. According to the some study results, endocrine manifestations of reproductive system disorders, including polycystic ovary syndrome, may be more common in women treated with valproate than in those treated with other AEDs.

Background: The incidence of acute SAH has been estimated at 2–22 cases per 100 000 persons per year. The most common cause of basal acute SAH is a ruptured cerebral aneurysm. Cerebral vasospasm in the first 2 weeks after aneurysmal subarachnoid hemorrhage is recognized as a major predictor of delayed cerebral ischemia. From 2014 through 2018, 5272 patients with a stroke (amongst them 20.4% were patients with aSAH) were hospitalized in the 3rd State Central Hospital of Mongolia. Objective: To study the clinical features of the cerebral vasospasm and dopplerosonography parameters in the aSAH patients. Materials and Methods: The methods, methodology and ethics of the research work were discussed at a Research meeting of Ethics Control Committee of the Mongolian National University of Medical Sciences held on December 22, 2017 (No2017 / 3-05), and the study was performed in accord with approval.
60 patients with aSAH (hospitalized from 2017 to 2018 year) were enrolled in the case-control study. Informed consent were obtained from each participants. Clinical condition of participants was classified by Hunt-Hess scale (HHS). Cerebral vasospasm degree was graded by Lindegaard index. Results: 52.5% of the participants were men and 47.5% were women. Average age was 49.9±12. When clinical condition degree was compared to vasospasm grade it was revealed that amongst 1st degree of Hunt-Hess scale (HHS) group 11.1% of enrolled patients’ spasm was normal or had no spasm, while it was observed either 44.4% mild and moderate spasm. In the 2nd degree of HHS group: normal in 6.9%, mild in 3.4%, moderate in 86.2%, and severe spasm was in 3.4%. In the 3rd degree of HHS group, 11.1% had no spasm, moderate spasm was in 77.8%, and severe spasm was in 11.1%. In 4th degree of HHS group, 71.4% were with moderate spasm, 28.6% were with severe spasm (p = 0.001).
When the Hunt-Hess Scale was compared to the Sinus Rectus 1st degree of Hunt-Hess scale (HHS) group Sinus Rectus was normal for 22.2% patients, mild for 66.7% and severe for 11.1%. Though 4th and 5th degree of Hunt-Hess scale (HHS) groups’ Sinus Rectus mild for 7.1% normal, 50.0% mild and 42.9% severe (p=0.007). Thus whenever the clinical condition worsened the cerebral intracranial pressure was increasing. Conclusion aSAH patients clinical complication degree were directly associated with the cerebral vasospasm revealed by the transcranial dopplerosonography. Therefore, the evaluation of Hunt-Hess scale has an important significance in the prevention from clinical complications and in the selection of the appropriate treatment approaches for aSAH patients.

Introduction: After central nervous system injury, microglia cells are activated to initiate inflammatory responses and release cytokines that beneficially or detrimentally affect surrounding cells. Lipopolysaccharide stimulates microglia cells and produce pro-inflammatory cytokines such as interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α. A dehydrocostus lactone (DDL) which is contained in medicinal plant, Saussurea lappa, is considered to have various health benefits in neurodegenerative diseases of central nervous system.
In this study, we aimed to investigate the anti-inflammatory effects of Dehydrocostus Lactone following lipopolysaccharide stimulation of microglial cells in vitro. Materials and Method: The anti-inflammatory effects of dehydrocostus lactone were studied using lipopolysaccharide (LPS) stimulated murine microglia (BV2). BV2 were cultered in DMEM then three different doses (4µM, 8µM and 12µM) of DDL were added in the medium for 30 minutes respectively. Then BV2 were treated with 1 ng/ ml LPS for 24 hours to stimulate. The level of IL-1β, IL-6 and TNF-α were measured in 100µl of culturemedium supernatant by ELISA. Three different doses of DDL anti-inflammation groups (BV2+DDL+LPS), LPS-activated group (BV2+LPS) and control group (only BV2) were analysed. Results: LPS-treated BV2 cells had increased IL-1β, IL-6 and TNF-α compared with those without LPS treatment. Pretreatment with dehydrocostus lactone prior to LPS treatment significantly decreased levels of IL-1β and TNF-α in a dose-dependent manner compared with LPS-treated BV2 cells and 4µM was the most effective anti-inflammatory dose of dehydrocostus lactone. As for IL-6, 12µM dehydrocostus lactone was the most effective anti-inflammatory dose, although all doses significantly decreased the level of IL-6, in a dose-dependent manner. Conclusion These results show that DDL decrease inflammation related IL-1β, IL-6 and TNF-α in a dose-dependent manner in microglia cells.

Objectives: To study the manifestations of the paroxysms, the variants of the course, and to determine the significant predictive factors for post-traumatic epilepsy (PTE) in Ulaanbaatar, Mongolia. Methods: We obtained the histories of 109 PTE patients who came to district health associations and the Central First Clinic in Ulaanbaatar from 2011 to 2013. We conducted a questionnaire and performed clinical examination to evaluate seizures in accordance with semiologic and international classification of epileptic seizures. Clinical data was matched with the results of electroencephalography (EEG), computed tomography (CT), and magnetic resonance imaging (MRI). Results: Of the 109 patients, 93 (85%) presented with secondary generalized partial seizure (SGPS), 16 (15%) with partial seizure and 66 (60.5%) with motor phenomena. The seizure frequency was not correlated with the structural brain abnormalities, but there was an inverse association (r=-0.32, p<0.001) between seizure frequency and the duration of PTE. PTE was positively correlated with severe injury, contusion, early onset of seizures (p<0.05), and operative brain injury (p<0.005). Conclusion: Clinical features of PTE were presented as secondary generalized seizure and motor phenomena in the majority of patients. PTE was characterized commonly by long durations of high seizure frequency and significantly affected by factors such as severity of head injury and operative brain injury.