Juvenile myoclonic epilepsy (JME) is characterized by myoclonic jerks on awakening, generalized tonic--clonic seizures (GTCS) and is associated with absence seizures in more than one third of cases. Fifteen patients with juvenile myoclonic epilepsy were studied with regard to their clinical profile, EEG data and sleep EEG findings. There was a delay in the diagnosis of JME (mean of 3.5 years) due to various reasons. Sleep deprivation was the most common precipitating factor for triggering seizures, followed by fatigue. Routine EEGs were abnormal in 73.33% of cases only and had misleading findings in 6.66%. Sleep EEGs were abnormal in 100% of cases with generalized spikes, polyspikes and slow wave discharges. Discharge rates on sleep EEGs typically increased significantly during the transition phase (i.e. the asleep to awakening stage) and we consider this to be a specific finding in appropriate clinical setting. Sleep EEGs are a more sensitive and specific tool for the diagnosis of JME while routine awake EEGs may miss or mislead.

Identify the various types of epilepsy surgery available and how the most appropriate procedure is selected. Discuss the different types of intraoperative neuromonitoring that may be indicated and the implications for anaesthesia care. Work as part of an interdisciplinary team including neurosurgeons and neurophysiologists to optimise outcomes for patients.Epilepsy is a common chronic neurological condition, with an estimated median incidence of 50.4 per 100,000 persons yr À1 , and is characterised by temporary neurological dysfunction manifesting as seizure episodes with focal, generalised or unknown onset. 1 Epilepsy increases the annual risk of sudden death to 5.4 times that of matched controls and is also associated with increased morbidity associated with seizures, including injuries from falls and burns. 2 Recurrent seizures can result in limitations to participation in education, employment, driving and social activities. In selected patients with epilepsy refractory to medical therapy, surgery represents the best option for curing or significantly improving their seizures. The term 'epilepsy surgery' refers to procedures aimed at resecting epileptogenic foci; disconnection surgeries to reduce seizure frequency and propagation; and procedures aimed at reducing seizure frequency via neuromodulation. The provision of anaesthesia care for these surgeries requires a comprehensive understanding of the underlying disease process and a collaborative interdisciplinary approach to intraoperative neuromonitoring. Aetiology of focal epilepsyPopulation studies suggest a predominance of the incidence of focal seizures over generalised seizures. 3 A variety of intracranial lesions may act as an epileptogenic focus and may be amenable to surgical resection. Hippocampal sclerosisAlso known as mesial temporal sclerosis, this condition is characterised by focal neuronal loss and gliosis particularly in the cornu ammonis area 1 and subiculum of the hippocampus. It is the most commonly encountered histopathological finding in epilepsy, identified in 36.4% of all surgical specimens. 4 Patients typically experience complex partial seizures with or without aura or progression to generalised toniceclonic seizures.

Post-menopausal bleeding is a common problem with varied etiology in the age group between 50 and 60 years. It is more likely to be of some pathologic cause which needs to be ruled out. Bleeding in a patient after hysterectomy is even rarer with varied causes like atrophic vaginitis, cervical stump cancer, infiltrating ovarian tumors, estrogen secreting tumors in other parts of the body. Endometriosis of the vault sometimes can cause post-menopausal bleeding. Diverticulitis of the bowel may give rise to vaginal discharge due to fistula, but bleeding is rare. Bladder pathology may cause vaginal bleeding. Our case is a rare case of vault endometriosis and should always be kept as a differential diagnosis in patients with bleeding after hysterectomy.

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