INTRODUCTIONEpilepsy affects 70 million people worldwide.(1) Long-term antiepileptic drug (AED) administration remains the mainstay of epilepsy treatment. In up to 67% of patients with epilepsy (PWE), AEDs effectively eliminate or reduce the frequency of seizures.(2) Medication adherence refers to the extent to which a patient's behaviour corresponds with the recommendations of a health professional. Medication adherence is usually better when there is greater patient involvement in the treatment choice, as well as cooperation and mutual agreement between the health provider and the patient.(2) Nonadherence rates among PWE are reported to be 30%-50%.(3) It is well established that patients with suboptimal adherence levels are more likely to have seizures that are associated with increased number of hospital admissions and healthcare costs.(4) Factors influencing adherence to AEDs have been described; these include patient-, treatment-and health system-related factors.(5) The promotion of medication adherence is considered to be an important component of pharmaceutical care practice. Several methods have been used to measure therapeutic adherence, including self-report, pill count, appointment attendance, medication refill history, blood or urine drug levels and drug diary.(6) Indirect methods, such as self-reports and patient interviews, are the simplest and most common methods used for measuring medication adherence. (7,8) To date, most of the studies conducted to evaluate AED adherence among PWE did not account for the influence of a wide range of variables (e.g. demographic, disease and treatment patterns). There are not many studies in the Indian literature that examine the factors that influence AED adherence. Identifying the factors associated with AED adherence would allow the development of strategies to improve adherence. Thus, the present study aimed to evaluate the pattern and extent of AED adherence among PWE and to identify the factors that influence adherence. METHODSThis cross-sectional study was conducted by the Division of Clinical Pharmacology at the outpatient and inpatient clinics of the Department of Neurology, St John's Medical College and Hospital, Bangalore, India, over a period of 1.5 years (January 2012 to July 2013). Ethical approval was obtained from the institution's Ethical Review Board. Patients aged ≥ 18 years who were receiving AED treatment were eligible for inclusion in the study. Only those who gave their consent for participation were enrolled. Pregnant or lactating women and patients with comorbidities were excluded from the study.Data was collected using a specially designed case record form that included items on demographic/family history, seizure history, duration of epilepsy, AEDs prescribed and occurrence of

Appropriate tools for early detection, selection of rational and safer AED treatment options, and regular monitoring for adverse effects play a crucial role in achieving seizure freedom and optimal QOL in patients with epilepsy.

Background: COVID-19 related strokes (CORS) are increasingly being diagnosed across the world. The knowledge about the clinical profile, imaging findings and outcomes are still evolving. Here we describe the characteristics of a cohort of 62 CORS patients from 13 hospitals, from Bangalore city, south India. Objective: To describe the clinical profile, neuroimaging findings, interventions and outcomes in CORS patients Methods: Multicenter retrospective study of all CORS patients from 13 hospitals from south India from 1st June 2020 to 31st August 2020.Demographic, clinical, laboratory and neuroimaging data were collected along with treatment administered and outcomes. SARS-CoV-2 infection was confirmed in all cases by RT- PCR testing. The data obtained from the case records were entered in SPSS 25 for statistical analysis. Results: During the 3-month period we had 62 CORS patients, across 13 centers. 60 (97%) had ischemic strokes while 2 (3%) had hemorrhagic strokes. The mean age of patients was 55.66 ±13.20 years, with 34 (77.4%) males. 26 % (16/62) of patients did not have any conventional risk factors for stroke. Diabetes Mellitus was seen in 54.8%, hypertension was present in 61.3%, coronary artery disease in 8% and atrial fibrillation in 4.8%. Base line NIHSS score was 12.7 ±6.44. Stroke severity was moderate (NIHSS 5-15) in 27 (61.3%) patients, moderate to severe (NIHSS 16-20) in 13 (20.9%) patients and severe (NIHSS 21-42) in 11(17.7%) patients. According to TOAST classification for ischemic strokes, 48.3% was stroke of undetermined etiology, 36.6% had large artery atherosclerosis, 10% had small vessel occlusion and 5% had cardioembolic strokes. 3 (5%) received intravenous thrombolysis with tenecteplase 0.2 mg/Kg and 3 (5%) underwent mechanical thrombectomy two endovascular and one surgical. Duration of hospital stay was 16.16± 6.39 days. 16% (13/62) died in hospital, while 37 (59.7%) had a mRS of 3-5 at discharge. Hypertension, atrial fibrillation and higher baseline NIHSS scores were associated with increased mortality. A comparison to 111 historical controls during the non COVID period showed a higher proportion of strokes of undetermined etiology, higher mortality and higher morbidity in CORS patients. Conclusion:CORS are increasing being recognized in developing countries like India. Stroke of undetermined etiology appears to be the most common TOAST subtype of CORS. CORS were more severe in nature and resulted in higher mortality and morbidity. Hypertension, atrial fibrillation and higher baseline NIHSS scores were associated with increased mortality.

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Aim:To compare the efficacy and safety of gabapentin (GBP), duloxetine (DLX), and pregabalin (PGB) in patients with painful diabetic peripheral neuropathy (DPNP).Methods:A prospective, randomized, open label, 12-week study was conducted. A total of 152 patients with history of pain attributed to DPNP with a minimum 40-mm score on visual analogue scale (VAS) were randomized to receive GBP, DLX, or PGB. The primary efficacy measure was pain severity as measured on 11 point VAS. Secondary efficacy measures included sleep interference score, Patient Global Impression of Change (PGIC), and Clinical Global Impression of Change (CGIC). Assessment of safety was done by recording the occurrence of adverse drug reactions. Data was analyzed using descriptive statistics, Chi square test, analysis of variance (ANOVA), and repeated measures ANOVA.Results:Of total 152 patients, 50 patients received GBP, DLX each while 52 received PGB. A significant reduction in pain score (VAS), sleep interference score, PGIC, and CGIC was seen in all the three treatment groups across time (P<0.05) with no statistically significant difference between the groups. There was a significant interaction between the time and treatment groups (P<0.001) for pain score (VAS), sleep interference score, and PGIC. The improvement in pain scores (VAS) and sleep interference score was higher with PGB compared to DLX and GBP. Adverse drug reactions were mild and occurred in 9.2% of all cases.Conclusions:Monotherapy with GBP, DLX, or PGB Produced a clinically and subjectively meaningful pain relief in patients with DPNP with onset of pain relief being faster and superior with PGB.