Background and PurposeThe Magnitude of Drug-resistant Epilepsy (DRE) in India, being unknown, takes a heavy toll on the patients and society in the form of prolonged dependence, unemployment, morbidity and mortality. We tried to explore the clinical, electro-physiological, neuro-imaging and drug-response spectrum of DRE patients in Eastern India in our study.MethodsDuring the period of January 2014 to December 2015, epilepsy patients were treated and DRE patients were identified according to International League Against Epilepsy criteria. We isolated those patients and studied them in a special clinic.ResultsAmong 2,153 patients treated in Neurology out-patient department, 243 (11.3%) patients were drug-resistant. Among the DRE patients, 63% were male. Age-wise 40%, 30.5% & 18.1% patients were presented in their first, second and third decades respectively. Males were more affected in 0–5 years age group while females in 6–10 years age group. Various seizures types were found alone or in combination. Males were mostly affected by generalized tonic clonic seizure and myoclonus and females by complex partial seizure. Positive family history was higher in partial seizure group. Electroencephalographic (EEG) abnormalities were common with structural lesions in brain. EEG findings in different etiologies were varied with a large number of DRE patients who were found to have normal EEG. Females were higher medicine non-compliant.ConclusionsThe spectrum was pointed towards gender predilection for specific age group and also for seizure types. Idiopathic cases were most common in DRE, pointing towards the need of newer investigations. Normal EEG could be found even in a DRE patient. Non-compliance was more in females.

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Background: Epilepsy is a disease of suffering. Drug-resistant epilepsy (DRE) takes a heavy toll on patients, family and society in the form of prolonged treatment, expenditure, unemployment and disability. Successful treatment depends on appropriate antiepileptic drug (AED) use in appropriate dosage, which varies in different parts of the world. Aims and Objectives: To find out AED efficacy in Indian subcontinent and factors affecting seizure freedom. Materials and Methods: We explored many characteristics of DRE patients, compared in between seizure-free and seizure-persisting patients to find out the variables more affecting seizure-freedom. We measured minimum effective dose and maximum tolerable dose of different AED in child and adult subgroups in patients of the Indian subcontinent. Results: Lamotrigine was most efficacious in various seizure-types and phenytoin was the least one as first add-on AED. Clobazam was efficacious and good-compliance second add-on AED. AED compliance was significantly reduced as the number of AED was increased above two. AED monotherapy was most effective and the effectiveness decreased as subsequent AED was added as per need. Conclusion: Our study enlightened about various aspects of drug-resistant epilepsy patients in Indian sub-continent and their treatment.

Progressive multifocal leukoencephalopathy (PML) is a rare subacute-onset fatal demyelinating disease of the central nervous system caused by the John Cunningham (JC) virus. It usually occurs in impaired cell-mediated immunity settings such as lymphoproliferative disorders, chronic infective or granulomatous conditions on immunosuppressive medications, and human immunodeficiency virus infection. It also appears very rarely with idiopathic CD4 lymphocytopenia. We present a case of PML with visual field defect, progressive motor impairment, behavioral alteration, and dementia. Magnetic resonance imaging had features of asymmetric non-enhancing hyperintense subcortical white matter lesions in the background of chronic active hepatitis B infection. To the best of our knowledge, this is the first case report of CD4 lymphocytopenia associated PML following chronic hepatitis B infection.