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ABSTRACT BOOK

The Third Annual UAE Epilepsy Congress and First
Joint Emirati Saudi Meeting, April, 4th-5th, 2014,
Grand Hyatt Hotel, Dubai, United Arab Emirates
Guest Editor: Taoufik Alsadi1
1Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
Abstract of Presentations
thereby permitting individually targeted preventive therapies; to predict the type of treatment most Presidential Lecture. Pharmacogenetics in
appropriate for the individual's epilepsy; to allow Epilepsy
early identification of drug resistance; and to discover new targets for the development of innovative and Emilio Perucca, University of Pavia, Pavia, Italy
more effective AEDs. Pharmacogenetic information is already usefully applied in the routine clinical In recent years, there have been impressive advances management of epilepsy in some situations, the best in the elucidation of the genetics of epilepsy example being HLA-B*1502 genotyping to minimize syndromes. Most of these studies have focused on the the risk of serious cutaneous reactions induced by identification of genetic defects which may cause carbamazepine and some other AEDs in patients from epilepsy, and correlations between the identified certain Asian ethnic groups genetic defects and the phenotypic expression of the Plenary Lectures
disorder. Significant efforts, however, have also been placed into investigation of genetic factors which may PL1.1. The Role of EEG in the World of Epilepsy
influence response to antiepileptic drugs (AEDs). Ateeq Haseeb, Mercy St. Vincent Medical Center,
Available evidence suggests that genetic factors can Ohio, United States of America
affect AED response in at least four ways (i) through modulation of individual susceptibility to certain adverse Electroencephalography (EEG) is the recording of idiosyncratic AED reactions; (ii) through genetically cerebral electrical activity by placing multiple controlled variation in drug metabolism, particularly electrodes on the scalp. The source of the electrical with respect to polymorphically expressed cytochrome activity is the neurons where there is a constant P450 enzymes such as CYP2C9 and CYP2C19; (iii) exchange of ions resulting in excitatory and inhibitory through regulation of the expression of drug action potentials. EEG activity is summation of these transporters, such as p-glycoprotein, which influence action potentials produced from the thousands and the access of AEDs to their site of action in the brain, millions of neurons in the cerebral cortex. and may play an role in the resistance to a variety of EEG is very helpful in diagnosing and treating several AEDs; (iv) through genetically determined alterations neurological conditions. This includes diagnosing of AED targets, which can result in altered sensitivity patients with new seizure disorders, non convulsive to the therapeutic action of specific AEDs. status epilepticus, structural lesions, differentiating Elucidation of these factors is likely to have epileptic from non epileptic spells, and assessment of increasingly important practical implications for the cerebral activity during brain death evaluation. EEG management of epilepsy in the future, for example to also aids a Neurologist to make the right choice of a minimize the risk of serious adverse effects; to identify antiepileptic medication for particular epileptic individuals at high risk of developing epilepsy, syndromes, as well aids Neurologist to make decisions risk, and optimal patient care requires careful to discontinue antepileptic medications. balancing of these risks and potential benefits. EEG also has surgical applications. When used as a Assessment of risk requires not only establishing the prolonged or continuous video EEG over a period of 3 statistical risk of a seizure recurrence or of an adverse to 5 days combined with other neuroimaging event, but also the consequences of such an event. In techniques, it helps in getting information on seizure most patients, treatment should be deferred until a semiology and localization of the epileptogenic focus. second seizure has occurred. However in some This will lead to a higher chance of successful focal patients the decision could be different. The choice at resection of the epileptogenic cortex and a greater the end should be made jointly by the medical chance of seizure free outcome. EEG is also used providers as well as the patient and family after careful intraoperatively during carotid endarterectomies when assessment of risk and impact of seizure recurrence. making decisions for shunt placement during these PL1.3. Epilepsy Mimickers
Sonia Khan, Prince Sultan Military Medical City,
This objectives of the presentation will be as follows: Riyadh, Saudi Arabia
a) Educate participants on the details of EEG, b) Outline clinical and surgical applications of Paroxysmal events in children & adults can mimic epileptic seizures, and many of them have only been c) Elucidate the role of EEG in the world of recently described, or are only now being increasingly recognized. An awareness of the different mimickers PL1.2. First Seizure: What a Neurologist Should
of epilepsy and the art of history-taking will help pediatricians ,physicians and neurologists differentiate epileptic from nonepileptic events. Nonepileptic Khaled Zamel, Mafraq Hospital, Abu Dhabi,
paroxysms can present with drop attacks, limb or eye United Arab Emirates
jerks, and abnormal postures.One of the most common reasons for a misdiagnosis of epilepsy is a Unprovoked seizures are a common occurrence, psychogenic nonepileptic seizure (PNES), also termed affecting approximately 4% of the population by age pseudoseizure. Psychogenic nonepileptic seizures 80. The treatment of a first unprovoked epileptic (PNES), are defined as paroxysmal changes in seizure has been and continues to be one of the most behavior that resemble epileptic seizures but are often debated issues in epilepsy. without organic cause and are not accompanied by the ictal, peri-ictal, and interictal changes that characterize In this presentation, treatment issues following a first epilepsy. PNES is often suspected in patients with a unprovoked seizure are discussed, using an approach that emphasizes weighing the relative risks and comorbidity, and when spells are characterized by benefits of the therapeutic decisions. Well-designed unusual features, such as emotional triggers, prospective studies of the recurrence risk after a first prolonged duration, stop/start quality, or pelvic unprovoked seizure in children and adults show thrusting. However, the diagnosis of PNES can be recurrence risks in the 40 to 50% range leading to a difficult to make based on clinical criteria alone. The diagnosis of epilepsy. Risk factors for seizure standard of care for diagnosing PNES remains the recurrence include a history of remote neurologic recording of a patient's typical event with video-EEG to confirm the absence of electrographic changes on electroencephalogram, focal structural lesion on the ictal EEG recording during the spell, while neuroimaging, and family history of epilepsy. simultaneously evaluating semiology for either PNES behaviors or a lack of ictal characteristics.The Treatment trails clearly demonstrated that antiepileptic incidence of PNES is reported to be 1.5 per 100,000 drugs reduces recurrence risk but does not alter long- per year that is approximately 4% of the incidence of term prognosis. The therapies available carry some all epilepsy. Yet, PNES accounts for between 25% and patients that have altered mental status in intensive 45% of all video-EEG admissions to epilepsy care units (ICUs). Many studies have shown that about monitoring units Another common cause of 20% of patients undergoing ICU EEG monitoring misdiagnosis is syncope. When people black out, they frequently have a few jerking movements that may seizures or NCSE. It is not clear when intermittent seem like a seizure. However, these jerking episodes electrographic seizures become NCSE. Nor is it clear do not last as long as an actual seizure, and the patient what impact these electrographic seizures have on usually recovers more quickly. While syncope can be outcomes and how aggressively they should be caused by benign etiologies such as dehydration, it may also be caused by serious cardiac disorders, so it This lecture will explore these issues, outlining current is crucial to determine the etiology of syncope with knowledge and uncertain areras. We will discuss the confidence. Migraines are usually associated with definition and EEG characteristics of different forms headache, but can also cause unusual symptoms that of NCSE and the utility of EEG monitoring as well as mimic seizure activity. For example, migraine with the frequency with which electrographic seizures and aura is preceded by visual symptoms .Complicated NCSE are detected in critically ill patients. Finally, we migraine can be followed with numbness and will discuss new treatment paradigms for critically ill hemiplegia even without the headache. Other seizure patients with electrographic seizures and NCSE and mimickers include transient ischemic attacks or how that may differ from the treatment of convulsive hypoglycemia. In short, not every seizure like event is status epilepticus. a seizure . Because the diagnosis of epilepsy is sometimes unclear & can have serious consequences, PL2.2. Status Epilepticus: An Update
it's important to rule out other potential mimickers before starting anti epileptic medications. It's best to Iyad Khoudeir, Noor Hospital, Abu Dhabi, United
Arab Emirates
have a thorough evaluation by a neurologist and perhaps in the epilepsy monitoring unit to exclude mimickers of epilepsy. This review describes the Status epilepticus is a severe neurologic condition with different mimickers of epilepsy and focuses on their significant morbidity and mortality. It requires urgent medical evaluation and an early and aggressive pathophysiology, and other manifestations that help treatment before irreversible neuronal damage occurs. distinguish them from epilepsy. The definition of the timing to begin a protocol PL2.1. Non Convulsive Status Epilepticus
treatment of a status epilepticus and classification of status epilepticus need to be clear in the minds. In Eugen Trinka, Paracelsus Medical University,
addition to recognizing the underlying etiology, a Frankfurt, Germany
prompt and specific treatment is a must to ensure successful treatment. Nonconvulsive status epilepticus (NCSE) is the The management of status epilepticus remains a persistence of a seizure with little or no clinical challenge. A rapid treatment and avoiding medical activity or the occurrence of two seizures without systemic complications are keys. return of normal mentation between the seizures. Previously NCSE was diagnosed when the seizure had An agreement exists about first line treatment as well lasted at least 30 minutes or the time between two as about second line therapies with phenytoin or seizures was at least 30 minutes. More recently some valproic acid. Pre-hospital treatment with an IM investigators have proposed that the 30-minute time be Midazolam is being encouraged more so if an IV line reduced to 5 minutes as neuronal injury can occur in for Lorazepam is difficult to obtain and has shown to this time frame in some SE forms. improve the results of the treatment in the emergency room as well as the outcome and to reduce the Over the last decade, continuous EEG (cEEG) incidence of refractory status epilepticus. Newer monitoring has been increasingly used to evaluate the flattening of the electroencephalogram before any Lacosamide are being used; this is far to be based on fatal cardiac or respiratory arrest. It has been hypothesized that a primary cause could be Although there is an agreement on using a general an alteration of cerebral blood flow auto regulation, anesthesia in case of refractory status epilepticus; the which could lead to a sudden drop in cerebral choice of which anesthetic to use remains a "personal perfusion and subsequent cessation of electrical choice". A super-refractory status epilepticus is now accepted as the one persisting or recurring beyond 24 PL3.1. Continuous Spike Wave during Sleep
hours of use of an anesthetic. (CSWS) and the LKS
Guidelines are available and a written protocol for therapy to be followed by ER physicians, neurologists Ahmad Beydoun, American University of Beirut,
and intensivists is recommended to enhance the Beirut, Lebanon

chances of success in treating this urgent and challenging neurological condition. Encephalopathy with continuous spike-waves during slow sleep (CSWS) and the Landau-Kleffner PL2.3. SUDEP: Where We Stand?
syndrome (LKS) represent the extremes of the Salah Baz, Royal Commission Hospital, Jubail,
spectrum of maturational epilepsies. They are both Saudi Arabia
age-related epileptic encephalopathies characterized by the development of psychomotor regression Sudden unexpected death in epilepsy (SUDEP) is a temporally associated with the appearance of specific significant cause of death among patients with types of epileptiform discharges that are highly epilepsy. Recent research suggests that multiple activated by sleep. factors may contribute to SUDEP and that both cardiac The LKS is a functional disorder of childhood and respiratory mechanisms are involved. characterized by seizures that are relatively easy to Both cardiac and respiratory abnormalities are highly treat and self-limited, an acquired aphasia, an EEG likely to occur with generalized tonic–clonic seizures. showing epileptiform discharges over one or both Uncontrolled epilepsy appears to be the most highly temporal regions and lack of discernible brain associated modifiable risk factor for SUDEP. In most pathology that can explain the symptoms. The witnessed or recorded events, sudden death is disorder typically presents with speech disturbance immediately preceded by a seizure. The risk for between the ages of 3 and 8 years in a child who has SUDEP appears to be closely related to seizure control, and patients with refractory epilepsy are at the production. The onset initially consists of a loss of highest risk for SUDEP; 30–50% of the patients are understanding of spoken language following which found dead in bed, and often, they are found in the the speech output is disrupted and paraphasias and phonologic errors begin to appear. In severe instances, the child becomes entirely mute and does not respond We present the case of a 22-year-old woman wherein to nonverbal sounds as well. The most common seizures include nocturnal hemiclonic seizures, electroencephalogram monitor during admission at the atypical absences, or secondary generalized seizures. epilepsy monitoring unit of our centre for the They have a variable relation to the language deficit, classification and management of nocturnal refractory and 20% to 30% do not exhibit behavioral seizures at all. Characteristically, the seizures have a benign All the patient's seizures were nocturnal and the last course, respond well to treatment with anticonvulsants and usually resolve on their own by the midteen years. seizure lasted for 90 seconds, followed by immediate isocerebral inactivity and death. Only three cases of CSWS is a functional disorder of childhood SUDEP have been reported thus far with recording of characterized by spike waves occupying 85% of the sleep recording, self-limited clinical seizures, IS typically exhibit the electroencephalographic behavioral and cognitive deterioration with or without pattern known as hypsarhythmia. The combination of premorbid developmental disturbances, and no brain IS with hypsarhythmia is referred to as West pathology sufficient enough to explain the behavioral syndrome. IS has been used to refer to either a seizure deterioration . The onset is usually in the first decade, type or an epilepsy syndrome. Patients with the with a mean age at onset of 4 to 5 years. All children syndrome of IS may have other seizure types; also, have cognitive decline during the period of seizures similar to IS may occur in other epileptic paroxysmal EEG manifested as reduced attention span, hyperactivity, abnormal behavior, aphasias, and While relatively rare, IS is a significant disorder apraxias. The seizures are commonly nocturnal and because of its strong association with developmental manifest as focal motor, complex partial, absence, and delay or regression (75 to 93 percent of affected secondary generalized tonic-clonic. Diurnal atonic children), high mortality rate, refractoriness to seizures and drop attacks can occur. Tonic seizures do conventional antiepileptic drugs, and responsiveness not occur. Compared with LKS, the seizures are more to hormonal therapy. frequent in CSWS, but, like LKS, they tend to respond to anticonvulsant therapy. The epidemiology, etiology, pathogenesis, and pathology of IS are reviewed here. In addition, the The diagnostic evaluation of children with a suspected clinical features and diagnosis, and management and diagnosis of LKS or CSWS consist of long-term of prognosis will be discussed. video-EEG monitoring, an epilepsy protocol brain MRI and sometimes functional neuroimaging (PET, PL3.3. Genetics in Epilepsy
SPECT). The treatment of those conditions vary Riadh Gouider, Razi Hospital, Tunis, Tunisia
across institution due to the paucity of controlled clinical trials. Valproate with or without a BZD appear to be the AEDs of choice. It is important to try Genetic factors contribute to etiology in up to 40% of to avoid CBZ, PHT, OXC, and PB since they can patients with epilepsy. Most of the epilepsies are worsen those conditions. Other treatments include believed to be polygenic with an evidence of complex steroids, IVIg, and multiple subpial transections for inheritance due to multiple susceptibility genes. children diagnosed with the LKS. The long-term Nearly 1 to 2% of epilepsies are monogenic or prognosis for seizure disorder in both conditions is Mendelian. They include symptomatic epilepsies, good, with 20% having persistent, usually rare, where there is associated diffuse brain dysfunction, seizures. However, the long-term neuropsychologic and idiopathic ones. consequences are not benign. The majority of patients The genetic architecture of the idiopathic epilepsies who have either disorder have some permanent (IE) is unknown. Genes responsible for a small sequelae that limit their activities. Those with the number of rare Mendelian IE have recently been earliest onset of spike and- wave discharges and longer identified and shown to encode ion channels involved persistence of epileptiform discharges have the worse in neuronal excitability. They are in majority neuropsychological sequel. Aggressive early responsible of autosomal dominant (AD) epilepsies. treatment might prevent or halt the psychomotor However, IE with autosomal recessive (AR) inheritance were rarely reported worldwide and few PL3.2. Epileptic Spasms: Current View
genes have been identified such as for benign rolandic epilepsy. These AR IEs seemingly occur as sporadic Raida Al Baradei, KFSH-D & Dammam
conditions and are underestimated because of the University, Dammam, Saudi Arabia
lower clustering of familial cases in studied populations compared to AD ones. AR inheritance Infantile spasms (IS) is an age-specific (most patients was proposed for few focal and generalized IEs, and have onset between 3 and 8 months of age) epileptic while some loci were described, no genes responsible disorder of infancy and early childhood. Children with for AR IEs have been identified, and the pathogenesis of these disorders remains unknown. Childhood absence epilepsy (CAE) is a common form considerations related to the effect of reproductive of idiopathic generalized epilepsies (IGEs) for which hormones to seizures, pregnancy, lactation, special causative genes are unknown. Several AD genes side effects of antiepileptic drugs (AED) and several cause absence seizures in families with heterogeneous social restrictions resulted from epilepsy. Fertility IGEs, and several genes encoding subunits of voltage- rates are reduced, one third of them may suffer from gated calcium channel or c-aminobutyric acid abnormal ovarian function, including anovulatory (GABA)A receptors are potential susceptibility factors menstrual cycles and polycystic ovaries. These for CAE in humans. No genes are known for AR complications may be more common in patients given CAE. However, four genes, encoding α1, β4, α2δ2, sodium valproate. and γ2 subunits of voltage-gated calcium channels Enzyme inducing AEDs such as carbamazepine, cause absence seizures in the spontaneous AR mouse phenytoin, phenobarbital, primidone, topiramate, and models Cacna1a in tottering (tg); Cacnb4 in lethargic oxcarbazepine can induce the hepatic pathways (lh); Cacna2d2 in ducky (du); Cacng2 in stargazer responsible for catabolism of female sex hormones, (stg). In a previous study, we excluded these genes in which leads to alterations in the menstrual cycle and five Tunisian families with an AR CAE. increase the turnover of oral contraceptive pills and Juvenile myoclonic epilepsy (JME) is another steroid hormones which can increase the risk of common specific familial IGE trait that has been unexpected pregnancy. subject to extensive linkage analysis. It is clinically Long term AED treatment with especially inducer and genetically heterogeneous and its mode of drugs can produce osteomalacia and osteoporosis. inheritance is still debated as there have been reports This is, in part, due to induction of vitamin D of AD, AR inheritance, and multifactorial models. metabolism but reduction in bone density may also Few AR loci were suggested for JME. An association happen with non-inducing AEDs. Vitamin D and with HLA was suspected in 32 unrelated Arab patients calcium supplementation are important in this with JME. Recently a locus was identified in Tunisian In some women seizures aggravate during their Progress in identifying the causative genetic defects is menstrual cycle, which is known as catamenial near complete in a subset of symptomatic epilepsies epilepsy. The use of intermittent clobazam just before caused by chromosomal abnormalities, amino- and shortly after the onset of menstruation may be acidopathies and lysosomal disorders. Molecular helpful in these conditions. analysis can be crucial for their diagnosis and prognosis: for example diagnosis in the progressive There is a higher risk of major congenital myoclonus epilepsies (PME) is largely based on malformations (MCMs) with valproate (VPA), molecular findings. Unverrich-lundborg disease compared to carbamazepine (CBZ), and possibly (ULD), the most common form of PME worldwide, is compared to phenytoin (PHT) or lamotrigine (LTG). frequent in Tunisia. Through our experience, AED polytherapy probably contributes to the phenotypic particularities were noticed in some development of MCMs and reduced cognitive geneticay proven UD families suggesting that outcomes compared to monotherapy. Intrauterine modifying factors may exist, either genetic or exposure to VPA, PHT or phenobarbital (PB) may environmental, that influence the effect of the major reduce the cognitive outcomes. Neonates of WWE taking AEDs probably have an increased risk of being small for gestational age and possibly have an PL4.1. Women and Epilepsy
increased risk of a 1-minute Apgar score. However
Cigdem Ozkara, University of Istanbul, Istanbul,
these effects are mainly dose related especially for VPA when it is higher than 1000mg. If possible, avoidance of high doses of AEDs and polytherapy Taoufik Alsaadi, SKMC, Abu Dhabi, United Arab
throughout pregnancy should be considered. Emirates

Almost 70 % of the pregnancies remained seizure-free Once a patient has initiated an antiepileptic drug throughout pregnancy. Women with idiopathic (AED) and achieved a sustained period of seizure generalized epilepsies were more likely to remain freedom, the decision to discontinue AED should be seizure-free than with localization-related epilepsy. balanced against continuation of AED therapy Seizures were more likely to occur in the first trimester indefinitely. Studies show that the rate of seizure of pregnancies and pregnancies exposed to recurrence after AED withdrawal is about two to three lamotrigine were more likely to have seizures and times the rate in patients who continue AEDs. more GTCS. Monitoring of drug levels especially for However, there are many benefits to AED withdrawal LTG is considered as it causes an increase in the that should be evaluated on an individualized basis. clearance and a decrease in the concentrations. AED discontinuation may be considered in patients Supplementing WWE with at least 0.4 mg of folic acid whose seizures have been completely controlled for a before pregnancy is rcommended. The AED that prolonged period. There are several factors that would provides the best seizure control in monotherapy at the increase risk of recurrences which will be reviewed lowest effective dose should be chosen. Breastfeeding and discussed. As a consequence, the decision to should be encouraged for all the usual reasons withdraw or withhold treatment must be still however caution should be taken as Primidone and individualized. In any patient, the decision to levetiracetam probably transfer into breast milk in discontinue treatment should also take into effect the clinically important amounts. social aspects like driving license, job and leisure activities as well as emotional and personal factors and PL4.2. Epilepsy in the Elderly
patients with adverse effects or drug interactions. Patients will ultimately have to decide themselves Hassan Hosny, Cairo University, Cairo, Egypt
whether they wish to discontinue drug treatment. Debate 2.1. Benign Childhood Epilepsy with
Epilepsy has increasingly been recognized as very Centro-temporal Spikes: Treat or Not with AED
common in the elderly. Reasons for the rising incidence of epilepsy in the elderly are largely Ahmed Al Rumayan, Prince Sultan Military
unknown, but may include longer survival of people Medical City, Riyadh, Saudi Arabia
with underlying medical conditions such as stroke. Sonia Khan, Prince Sultan Military Medical City,
Stroke and other vascular catastrophes are the most Riyadh, Saudi Arabia
common risk factors for epilepsy in the elderly in addition to cerebral brain tumors and traumatic brain Benign epilepsy with centrotemporal spikes (BECTS) injuries. A diagnosis of neurodegenerative disease are is a common disorder in childhood. In regards to associated with at least six fold risk for epilepsy. Factors complicating the treatment of seizures in old qualifications, for example, treating those with early age groups include concurrent medical diseases, onset, multiple seizures at onset, and large numbers of polytherapy, changes in pharmacokinetics and altered seizures. After a brief overview of BECTS, a review pharmacodynamics. Many AEDs pose problems in the of the data in favor of treatment with anticonvulsant aged due to limited tolerability. medications is followed by the data indicating that treatment is not indicated, challenging against the judgment regarding treatment. Antiepileptic drug Debate 1.1. All Patients with Seizure Freedom for
(AED) treatment is often not recommended, 2 Years Should Discontinue AEDs
particularly if only simple partial seizures occur and if the child and family are comfortable with this Ahmad Beydoun, American University of Beirut,
approach . The goal of this debate is to assess the value Beirut, Lebanon
of treating versus not treating benign epilepsy (of OC2. Did We Know the Epilepsy Burden in Arab
childhood) with centrotemporal spikes (BECTS). Countries?
Oral Communications
OC1. Clinical Experience with AEDs
Hani Benamer, London, United Kingdom
Bernhard Steinhoff, Christoph Kurth, Kork,
Munich, Germany
The association between epilepsy and migraine has long been discussed. Epidemiological studies from Western and Asian populations showed that perampanel, three new antiepileptic drugs were individuals with epilepsy are (2-4) times more likely launched in Germany for add-on treatment of patients to develop migraine than their relatives without with partial-onset seizures. These new AEDs offer seizures. Studies showed that risk of migraine is unique modes of action. We collected their efficiency elevated in patients with both generalized and partial in difficult-to-treat patients at our tertiary referral Design and Methods The study is an observational, retrospective hospital- After the introduction of each drug (2008, 2011 and based study aimed to detect the type of epilepsy which 2012) patients were followed for at least six months on is more linked to migraine in Emirati patients whom add-on lacosamide, retigabine and perampanel. We are genetically different from Western or Asian assessed efficacy, tolerability and retention rate. We recruited 107 patients with lacosamide, 40 with Fifty Emirati patients diagnosed with epilepsy and retigabine and 74 with perampanel. 50% responder migraine were followed up in Neurology clinic at rates were 35%, 15% and 46%, respectively. Freedom AlQassami Hospital between October 2012 and of seizures for at least three months was achieved in October 2013. Data including age, sex, type and 5%, 2.5% and 14% of our patients. Adverse events duration of epilepsy, type and duration of migraine and were observed in 36% of patients under lacosamide, family history of both epilepsy and migraine were 40% of patients under retigabine and 54% of patients collected from each patient. The results were with perampanel. Six-month retention rates were 73%, expressed in percentages. 50% and 70%, respectively. There were thirty female patients and twenty male With all new AEDs we did see seizure freedom in patients. Their ages range between (15-35) years. The some of our very difficult-to-treat patients. It is epilepsy duration vary between (8-10) years while the tempting to speculate that the new mode of action of duration of migraine ranges between (4-8) years. each drug may have been an explaining condition. The Thirty-five patients (70%) have generalized epilepsy highest rate of seizure freedom but also most adverse and fifteen patients (30%) have partial epilepsy. events were seen with add-on perampanel. Retention Thirty-two patients (64%) have migraine without aura rates were similar for lacosamide and perampanel and while eighteen patients (36%) have migraine with lower for retigabine. aura. Juvenile myclonic epilepsy represents Twenty-five patients (60%) in the generalized epilepsy group. Other types are tonic clonic epilepsy (14%) and tonic epilepsy (14%). In the generalized epilepsy group, 20 patients (80%) have migraine without aura and 10 patients (20%) have migraine with aura. In the partial regards to when a patient should be allowed to drive epilepsy group, 10 patients (70%) have partial after a seizure (6months 46.3% vs 12 months 46.3%.) epilepsy with secondary generalization and 5 patients The majority of physician surveyed would allow a (30%) have complex partial epilepsy. Nine patients patient to drive if risk of reoccurrence is less than 25% (60%) out of them, have migraine without aura while (59.26). Majority of physician surveyed would all a six patients (40%) have migraine with aura. Twenty- patient to drive if they were seizure free for 6 months five patients (50%) with epilepsy have strong family after medication withdrawal. (53.85%) history of epilepsy. All these patients have juvenile myclonic epilepsy. Majority of physicians surveyed would allow a patient with only nocturnal seizures to drive. Juvenile myclonic epilepsy if found to be the OC4. Public Awareness and Attitude Towards
commonest type of epilepsy associated with migraine. Epilepsy in Saudi Arabia
Migraine with aura is the type of migraine which is more linked to epilepsy. Migraine is increased in Mohammed Jan, Riyadh, Saudi Arabia
epileptic patients with family history of epilepsy. This demonstrates a possible strong genetic basis between epilepsy and migraine. The co-morbidity of migraine There is a considerable misconception about epilepsy and epilepsy may be explained by a state of neuronal in our community. It is frequently linked to evil spirit hyper-excitability that increases the risk of both possession. Primary school teacher's knowledge and attitudes toward epilepsy can have significant impact on the performance and psycho-social development of OC3. Driving Restrictions of Patients with Seizure
the child with epilepsy. Parents' attitudes toward Ahmed Shatila, Taoufik Al Saadi, Abu Dhabi,
children with epilepsy are influenced by their United Arab Emirates
knowledge. Misconceptions should be identified and corrected for optimal care. We will present three studies that examined the public, teachers, and parent's knowledge and attitudes towards epilepsy in There are no driving guidelines in the UAE for patient Saudi Arabia and identify contributing factors to with epilepsy. The last study to asses accidents/driving negative attitudes. violations for epileptic patients in the UAE was in Our results included 749 public interviews, 620 primary school teachers, and 117 parents. Most of the public participants (77%) had prior knowledge about epilepsy which correlated with their educational level The purpose of this study is to help determine adequate as those with higher level of education were more driving guidelines in the UAE. likely to link epilepsy to organic causes (p= 0.008). However, 15% also linked epilepsy to evil spirit possession and up to 37% preferred spiritual rituals Fifty-Four licensed physicians who are currently and religious healing to medical treatments. Although practicing in the UAE and have experience treating most respondents (61%) would accept an epileptic epileptic patients were surveyed. A link to a 7 patient in a regular job, 71% reported reservations on question survey was emailed to the physicians marrying someone with epilepsy, particularly by males (p=0.001). Regarding the teachers, only 17% felt very well informed about epilepsy. Teachers with Most physician surveyed (87%) do not feel that they higher education were more likely to have goody should report all seizure cases to the DMV. In regards knowledge (p=0.009). Teachers of Saudi nationality to patient with epilepsy 50% feel no need to report. were also more likely to report good knowledge, The physicians surveyed were equally divided in independent of their educational level (p=0.013). Overall, teachers with good knowledge were less Orientation Of The Electrical Field Within It Rather likely to have negative attitudes including minding to Than Proximity To The Generator. have an epileptic child in their class (p=0.028) or This will be well explained in systematic review of thinking that they should be placed in a special EEG reading based on waveform recognition with classroom (p=0.029). Regarding the parents, most of respect to polarity convention and localization of them (70%) felt informed and recognized various neurogenerators. treatment modalities, many believed that epilepsy is a mental disorder (48%), correlates with evil (44%), or OC6. Modulation of Epileptic Focus and Network
affects the child's intelligence (38%). Up to 53% Faisal Al Otaibi, Dammam, Saudi Arabia
admitted to treating their child differently and avoiding upsetting or punishing him/her. This behavior was less likely if they achieved college Neuromodulation strategies have been proposed to education (p=0.01). Some parents (29%) admitted to treat a variety of neurological disorders, including using non-medical treatments, usually traditional or medication-resistant epilepsy. Electrical stimulation religious practices. Those parents were more likely to of both central and peripheral nervous systems has believe that epilepsy is a mental disease (p=0.002) or emerged as a possible alternative for patients who are correlates with evil (p=0.015). not deemed to be good candidates for resective procedures. In addition to well-established treatments OC5. Polarity Convention and Source Localization
such as vagus nerve stimulation, epilepsy centers Shireen Qureshi, Dammam, Saudi Arabia
around the world are investigating the safety and efficacy of neurostimulation at different brain targets, including The Art and Science of EEG reading is harmonious in subthalamic nucleus. Also promising are the way of recognition of waveforms ( spikes, sharp waves preliminary results of responsive neuromodulation and slow waves) and principles of neuro generator studies, which involve the delivery of stimulation to localization in the brain. EEG signal represent the the brain in response to detected epileptiform or summated electrical activity generated by large preepileptiform activity. In addition to electrical population of neurons (105 or more), mainly from stimulation, novel therapeutic methods that may open cortical neuronal layers. new horizons in the management of epilepsy include Neurons are aligned in bundles oriented perpendicular transcranial magnetic stimulation, focal drug delivery, to the cortical surface and activated by synapses on cellular transplantation, and gene therapy. We review soma-dendritic membranes. Neuron behaves as an the current strategies and future applications of extracellular, trans cortical, surface-to-depth, radially neuromodulation in epilepsy. oriented "dipoles", a generator with positive and OC7. Psychogenic Non Epileptic Seizures
negative poles. Pyramidal cells: major source of synaptic potentials, radially oriented. Solid angle Mashael Al Khateeb, Dammam, Saudi Arabia
theorem provides rational basis for principle of EEG localization. Solid Angle Theorem Provides A Epilepsy it's not always what you think - a series of Rational Basis For Principles Of Localization In EEG. videos showing different kinds of semiology for one The Potential (Voltage) Generated By A Neuronal Source Is Not Necessarily Directly Proportional To The Distance From The Source. Therefore One "In the field of epilepsy, original observations are Cannot Infer The Distance Or Depth Of A Source often the key to diagnosis and successful treatment. From Its Voltage Currents Are Not Restricted To The Indeed, the acumen to recognize the unexpected or Immediate Neighborhood Of The Generator. Potential unusual semiology distinguishes astute physicians. Difference Between 2 Electrodes Depends On Their Orientation With Regard To Configuration And (NEAD),are events resembling an epileptic seizure Feb 2008 – Feb 2014. 102 patients had 129 ,but without the characteristic electrical discharges pregnancies. Use of preconception folic acid ,type seen in epilepsy. and dose of AED use were studied .Anomaly scans were ordered for early bookers .New-borns were People with PNES can spend years in treatment for examined for Congenital malformations at birth . epilepsy, We believe that semiology of seizure are Gestation at delivery, mode of delivery & Birth weight important part in epilepsy classifications and treatment as well . For this reason I choose cases with different semiology but they share same diagnosis, that taught the clinician an important lesson and influenced the way they approached the care of their patients." 84% have generalised epilepsy , 11% partial epilepsy 5% others .20% consanguinity, only 62% with In this session , I will present challenging cases I confirmed preconception folic acid use . 90 % believe that many of you will be intrigued by these pregnancies exposed to AED. cases and perhaps see clues that we learn from patients as we try to unravel the mysteries of epilepsy. Despite the advances in technology, oftentimes original Three babies had major malformations. Multiple observations hold the key to diagnosis. And we hope confounding factors identified - lack of folate use, that these cases inspire clinical scientists to solve today's unanswered questions in epilepsy. malformations 80% of the IUGR babies are exposed to valproate. P2. AED Toxicity
P1. Epilepsy and Pregnancy
Khalid Alquliti, Jeddah, Saudi Arabia
Fathima.F , Nageena .M ,Bashir.S , Thoufik.A ,
Shahanaz. S ,Meera.A, Mariyam.N, Saira.M, Abu
Dhabi, United Arab Emirates
Epilepsy is affecting more than 50 million people worldwide, antiepileptic drugs (AED) is effective and Corniche hospital a major maternity hospital in remains the primary mode of management. Adverse Abudhabi , UAE with 8,000 -9,000 deliveries per effects of AED are important factor in treatment year Epilepsy is the commonest neurological disorder failure with major impact on health-related quality of in child bearing age . All major epilepsy and life in people with epilepsy. AEDs may cause dose- pregnancy registries confirm that exposure to anti related adverse or idiosyncratic adverse effects (i.e. epileptics ( AED ) is associated with 2-3 fold increased serious cutaneous, hematological and hepatic events). rate congenital malformations . Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and Drug rash with eosinophilia syndrome are among the severe cutaneous drug reactions that have been reported after AED, Our objective is to observe especially in high risk patients like older age, 1. Congenital malformations in foetuses exposed malignancy or radiation exposure. to antiepileptic's in our population along with other risk factors 2. Mode of delivery, Gestation at birth and birth To recognize the early clinical features of adverse drug reactions using a case study, clinical methods and tools that have been developed to recognize early adverse drug reactions and screen patient at high risk Prospective observational study of pregnant mothers attending Obstetric medicine Neurology clinic from We will present a case of TEN in patient with changes. They are found in a high percentage of phenytoin post-cranial radiation for brain metastases epileptics (42.2%) and are higher in patients with positive interictal electroencephalogram (46.7%) than Neuropharmacology of antiepileptic drugs including in those with negative interictal electroencephalogram history, Classification of AED, Pharmacokinetic Considerations, Other Clinical indication of AEDs and P4. Case Series: Neuro Cutaeneous Syndromes
adverse effect and multi-organ toxicity with special concern to clinical methods and tools like SCORTEN Naveen Divakar, Pushpagiri Institute of Medical
score (severity-of-illness Score for Toxic Epidermal Sciences, Kerala, India
Necrolysis) which calculates the risk for death in both Neurocutaneous syndromes (NCS) are a heterogenous AED can cause multiple adverse reactions which can group of disorders characterised by abnormalities of be serious and fatal, understanding of theoretical and both the integument and central nervous system that clinical aspect of AED Neuropharmacology are are believed to originate from a defect in essential for all physician who deal with these drugs to differentiation of the primitive ectoderm. Cutaneous implement treatment practice that minimize such manifestations usually appear early in life and adverse outcomes. progress with time, but neurological features generally P3. EEG/EKG Correlation
present at a later age. Mubarak Al Musafir, Royal Hospital, Muscat,
To study the clinical profile of children with neurocutaneous syndromes and their various Studying the incidence, types of cardiac arrhythmia's symptomatology, the seizure types and the response and there correlation with electroencephalographic changes and types of epilepsy may lead to a better Subjects and Methods understanding of the cause of Sudden Unexpected Death in Epileptics. A retrospective crosssectional study was conducted in the Department of Paediatrics, Pushpagiri Medical We recorded simultaneous electroencephalogram and College Hospital,Tiruvalla, during the period from electrocardiogram in 102 epileptics with equal number January 2013 to June 2013. Children between the age of males and females. Ages ranged from 6 months and group 0 and 15 years were included in the study on the basis of standard diagnostic criteria for different NCS. Forty six percent of patients with abnormal Investigations done were CT,MRI ,EEG,and skin electroencephalogram electrocardiographic biopsy for appropriate cases. abnormalities. Electrocardiographic abnormalities included: sinus tachycardia (63.8%), sinus bradycardia (10.6%), respiratory sinus arrhythmia (10.6%), The study population comprised of 10 children (5 ventricular ectopics (6.4%), atrial ectopics (4.3%) and boys, 5 girls). The various forms of NCS observed Electrocardiographic were Sturge Weber syndrome (SWS) – 4 abnormalities were most commonly found in patients Neurofibromatosis (NF1)- 2 , Hypomelanosis of Ito with generalised electroencephalographic discharges (HOI) – 2, Tuberous sclerosis complex (TSC) – 1 , and (57.1%), next in focal (43.8%), and last in focal with Incontinentia pigmenti (IP) – 1.A total of 8 children secondary generalisation (37.5%). (80%) presented with neurological symptoms and the remaining 2 (20%) presented with cutaneous Electrocardiographic abnormalities in epileptics symptoms of which 1 was found to have learning correlated well with the Electroencephalographic disability on evaluation.The neurological problems Design and Methods were,70 % had seizures of which100% were SWS and Colitis was induced by single intra-colonic application TSC , 50% were HOI and NF1 .72% had generalised of 20 mg Trinitrobenzene sulphonic acid in wistar rats. tonic clonic seizures (GTCS) and 28% had focal seizures. The child with TSC showed refractory different groups of animals. Another group of animals epilepsy. Developmental delay was detected in 50% was subjected to administration of normal saline in of cases and maximum delay was seen in HOI. Family colon without any treatment. After 14 days, seizures history of the same disease was obtained in 2 cases were induced by either intraperitoneal injection of (50% of NF1 and 100 % of IP). Pentylenetetrazole or by maximal electro shock in two different sets of experiments. Seizure score, colitis score, oxidative stress and TNFα, IL10 levels in brain The leading NCS in this study was SWS.70% of and serum samples was assessed. Histopathological children with NCS presented with seizures. The examination of colon was done. Naïve animal were commonest type of seizure among them is also taken for comparison. GTCS.Children with TSC had seizures refractory to anticonvulsants. Careful evaluation of NCS children can reveal problems like Learning disabilities. Mean colitis score decreased in thalidomide treated P5. Evaluation of Seizure Susceptibility in
group but not in Zonisamide treated group as compared to vehicle treated and naïve group. Seizure Sulphonic Acid Induced Ulcerative Colitis in Rats
score was decreased in Zonisamide treated group but not in thalidomide group as compared to vehicle Rakesh K Sewal, Manish Modi, Uma Nahar
treated or naïve groups. Seizure score was Saikia, Amitava Chakrabarti, Bikash Medhi,
significantly higher in vehicle treated group as Chandigarh, India

compared to non ulcerative colitis group. Oxidative stress was significantly lower in Zonisamide and Background and Objective thalidomide treated groups as compared to vehicle treated group. TNF α, IL10 levels results supported the Epilepsy is one of the most prevalent chronic abovesaid findings. There was no significant neurological disorders. There has always been a difference in groups of pentylenetetrazole or maximal substantial need to develop new antiepileptic drugs electroshock methods of seizure induction. and to understand the interplay between epilepsy and diverse conditions like inflammatory disorders to explore other prospective of possible therapeutic interventions. Study was designed to assess the seizure Seizure susceptibility may increase in experimental susceptibility in experimental models of ulcerative models of ulcerative colitis and anti-inflammatory agent may ameliorate this effect.

Source: http://www.elae.ae/doc/EP2014AbstractsScientific.pdf