Background:Oxidative stress has been a frequent finding in epileptic patients receiving antiepileptic drugs (AEDs). In this study, the influence of Vitamin E on the antiseizure activity and redox state of patients treated with carbamazepine, sodium valproate, and levetiracetam has been investigated.Materials and Methods:This double-blind, placebo-controlled trial was carried out on 65 epileptic patients with chronic antiepileptic intake. The subjects received 400 IU/day of Vitamin E or placebo for 6 months. Seizure frequency, electroencephalogram (EEG), and redox state markers were measured monthly through the study.Results:Total antioxidant capacity, catalase and glutathione were significantly higher in Vitamin E received group compared with controls (P < 0.05) whereas malodialdehyde levels did not differ between two groups (P < 0.07). Vitamin E administration also caused a significant decrease in the frequency of seizures (P < 0.001) and improved EEG findings (P = 0.001). Of 32 patients in case group, the positive EEG decreased in 16 patients (50%) whereas among 33 patients in control group only 4 patients (12.1%) showed decreased positive EEG.Conclusion:The results of this preliminary study indicate that coadministration of antioxidant Vitamin E with AEDs improves seizure control and reduces oxidative stress.

Purpose & Field:More than one hundred million people around the world undergo a surgery annually. Although, the surgery itself is a treatment method to relieve pain and discomfort, it can be considered as one of the important factors to make a pain too. Perception and diagnosis of the pain is the most important duty of nurses. Effective pain management after surgery facilitates the patient’s recovery, decreases the length of hospitalization and increases the patient satisfaction. This study aims to investigate the patients and nurses’ perception of the quality of pain management in the patients undergoing an abdominal surgery.Methods & Materials:The current study is a descriptive research that has been conducted on 204 candidate patients for the abdominal surgery and the nurses who care them in the departments of surgery of Rasht hospitals by using the Simple Random Sampling method. The necessary tools in gathering data for the questionnaire consist of demographic characteristics. Idval, E et al’s Questionnaire for evaluation and pain perception, numerical and visual evaluation tools for the patient and nurse satisfaction with pain relief. Statistical analysis has been made through the 16 version of SPSS software by using descriptive statistics, average and standard deviation.Findings:The results show that the level of patient satisfaction with providing necessary care to relieve pain was 29.1% (maximum), 20.8% (minimum) and 78.7% to the confidence, environment and all areas, respectively. For the nurses, this level was 32.4% (maximum), 16.4% (minimum) and 77.1% to the performance, environment and all areas, respectively. The maximum level of patient perception of satisfaction with pain relief was 49.1% and for the nurses, it was 37.7% (good level).Conclusions:The results indicated that the patients’ perception of providing necessary cares to relieve pain and their satisfaction with the pain relief are more than the nurses and in a good level.

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Background: Epilepsy surgery is a fundamental treatment in refractory epilepsy. Video electroencephalographic (v-EEG) monitoring plays an essential role in presurgical evaluation of patients. However there are reports of favorable outcome based on interictal and magnetic resonance imaging (MRI) findings without any need for v-EEG monitoring in patients with temporal lobe epilepsy (TLE). This study aimed to investigate the prognostic effect of concordance between interictal findings and ictal and MRI data on postsurgical outcome of TLE and extratemporal lobe epilepsy (ETLE). Methods: A retrospective study was conducted on 199 patients with refractory focal epilepsy who were admitted for presurgical evaluation. The concordance between irritative zone (IZ) and seizure onset zone (SOZ) and also IZ and MRI lesion was registered, and subsequently the prognostic effect of relevancy on 1-year follow-up result based on Engel criteria was investigated. Results: In TLE and ETLE regarding relevancy between IZ and SOZ, 77.8% and 73.2% were concordant, 2.5% and 0% were discordant, and 19.6% and 26.8% had overlap, respectively. Concordance between IZ and MRI lesion was found in 76.6% and 51.2% of patients with TLE and ETLE while discordance was recorded in 2.5% and 12.2% and overlap registered in 20.9% and 36.6%, respectively. The concordance of interictal findings had no effect on postsurgical outcome of patients with TLE and ETLE. Conclusions: Our study showed that concordance of IZ with SOZ and MRI has no independent effect on postsurgical outcome of patients with TLE and ETLE. We suggest that excluding exceptional cases, v-EEG monitoring should be considered as the mainstay of presurgical evaluation.

Background: Sleep Seizures (SSs) generally occur in refractory focal epilepsy, but their detailed characteristics and circadian patterns are still controversial. The effect of SSs on epilepsy surgery outcome has been addressed in few studies without definitive prognostic value. Objectives: This study investigated the characteristics of SSs and their prognosis in refractory focal epilepsy. Materials & Methods: This retrospective cross-sectional study was conducted in the referral epilepsy center in Isfahan, Iran from 2011 to 2015. It investigated SSs in patients with refractory focal epilepsy who underwent pre-operative evaluation. Demographic data, electroclinical findings, pathology, and postsurgical outcomes were analyzed and compared to Wake Seizures (WSs). Before the main analysis, Shapiro-Wilk test of normality was performed. Then the Independent sample t test, Chi-square test, Fisher's exact test, Mann-Whitney U test and 1-way ANOVA were used to analyze the obtained data in SPSS. All probability tests were two-tailed and the level of significance was defined as P≤0.05. Results: A total of 371 seizures in 113 patients were studied. The sleep/wake seizure ratio in Temporal Lobe Epilepsy (TLE) and Extratemporal Lobe Epilepsy (ETLE) were 0.54 and 0.91, respectively. The peak incidence of SSs in TLE and ETLE were during 4.00 to 8.00 and 0.00 to 4.00, respectively. SSs were considerably associated with EEG changes before clinical signs. Ictal EEG localization was more successful in SSs of extratemporal origin. Based on pathology findings, Focal Cortical Dysplasia (FCD) was highly associated with SSs. Left epileptogenic zone and FCD accompanied a less favorable outcome in SSs. Conclusion: SSs are significantly more frequent in patients with ETLE and follow specific circadian patterns based on epileptogenic zone. Seizure semiology and EEG findings are in favor of more localized onset of epileptic activity in SSs of extratemporal origin. The side of epileptogenic zone, circadian pattern of seizures, well-defined epileptogenic lesion in MRI and pathology, could affect postsurgical outcomes in SSs.