Neurological Disorders

Background: Status epilepticus (SE) represents a neurological emergency with high morbidity and mortality if not promptly treated. Intravenous phenytoin has traditionally been used as second-line anti-epileptic drug (AED) treatment, following benzodiazepines in SE, but is limited by adverse effects that include infusion-site reactions, hypotension and cardiac arrhythmias. Furthermore, as a potent enzyme-inducer, phenytoin may affect the efficacy of other drugs, thereby complicating treatment. Levetiracetam represents a more attractive second-line AED treatment as its administration is relatively straightforward (not requiring cardiac-monitoring) with a more favourable sideeffect profile and has minimal drug interactions.

Aim: The purpose of this article is to systematically review the evidence-base comparing the efficacy of intravenous levetiracetam versus phenytoin as second-line AED treatment (following benzodiazepine administration) in the management of SE in adults.

Methods: A literature search was performed in PubMed, EMBASE and Medline, for the search terms: Levetiracetam, phenytoin and Status Epilepticus. Articles were included for review providing they met all of the following inclusion criteria: Original research, published in the English language (up until August 2018) and Randomised-controlled trials (RCTs) of adult patients.

Results: Only 3 studies met the final inclusion criteria. These encompassed a total of 196 patients, from 3 RCTs, of whom 94 were treated with levetiracetam and 102 were treated with phenytoin. All 3 trials suggested equivalent efficacies of phenytoin and levetiracetam in the termination of seizure activity within 24 hours of drug infusions and similar functional outcomes at hospital discharge.

Conclusion: There is a surprising lack of controlled clinical data comparing the efficacy of levetiracetam with phenytoin in the management of SE in adults. Furthermore, existing trials are underpowered due to their small sample sizes, which makes their interpretation limited. Until further robustly designed, well powered, RCTs comparing levetiracetam with phenytoin suggest otherwise, levetiracetam may represent an attractive alternative to phenytoin in second-line AED treatment in SE in adults.

Guillain Barre Syndrome is an autoimmune disease and acute idiopathic polyneuritis condition. This is considered as Monophasic Immune Mediated Disorder (MIMD) and as acute inflammatory demyelinating poly-radiculoneuropathy in peripheral nervous system. Around 1-3 people affecting in 1,00,000 population. AMSAN and AMAN are rare subtypes of Guillain Barre Syndrome. The accurate cause of this disease is unknown. Around 2-12% people die due to GBS fallowed respiratory paralysis. Generally, Immunoglobulins (IgG) and plasma exchange given as effective treatment. Here we find a case of 18 years male patient presented with complaints of generalized weakness since 10 days and ascending paralysis followed by descending paralysis for one day. Based on family history and nerve conduction studies, it was concluded with AMSAN type of GBS. In order to treat the condition nutrition therapy, physiotherapy and steroids were given to the patient, though steroids are considered as ineffective treatment.

Background: Neurological disorders are an important cause of disability and death worldwide. Globally, the burden of neurological disorders has increased substantially over the past 25 years because of expanding population numbers and ageing, among that stroke is abrupt onset of neurologic deficit and attributable to focal vascular cause.

Objective: To determine the magnitude of neurologic emergency and associated factors among adult patient who visited the adult emergency department of Hawassa university compressive specialized hospital.

Method: Institution based cross sectional study was conducted among adult medical neurologic emergency patient at Hawassa Comprehensive Specialized Hospital, Ethiopia.

Results: A total of 3883 medical emergency patient cases were evaluated in the ER of HUCSH. Out of which about 422 (10.8%) were presented with neurologic emergencies. Among patients with neurologic emergency, 251 (59.6%) were males. The mean age of patients was 44.58+ 19.28 years. The main clinical presentation of patients with neurologic emergency were Speech difficulty and Hemi-paresis 123 (29.1%), followed by neck stiffens 43 (10.2%). Patients with Co-morbidity were 2.3 times more likely to have unfavorable neurologic emergency treatment outcome ( AOR: 2.30 (1.39-3.80)]. Patients who stay in hospital for 3-4 days were 69% less likely to have unfavorable neurologic outcome as compared to patients who stayed for 1-2 days (AOR 0.31, 95% CI 0.16, 0.60).

Conclusion: The magnitude of one-year neurologic emergency in the study area was found to be 10.8%. During neurologic emergency, longer hospital stay is advantageous. Presence of chronic disease or comorbidity has negative impact on neurologic emergency outcome. Young patients have better neurologic emergency outcome

Objective: Stroke is one of the most frequent causes of death and disability, urgent thrombolytic therapy can save thousands of lives and disabilities but unfortunately not all patients are eligible for thrombolysis. Dual antiplatelet are superior to anticoagulants in management of stroke and the use of full dose anticoagulants alone or in combination with aspirin is still debatable and carry the risk of hemorrhagic complications.

Aim of study: We aimed to compare the use double antiplatelet (oral Aspirin plus Clopidogrel) versus oral aspirin plus subcutaneous low dose enoxaparin in treatment of progressing stroke ineligible for thrombolysis.

Methods: The study was carried out on fifty-six patients presented with progressing stroke from February 2017 to the end January of 2019. Patients eligible for thrombolytic therapy (recombinant tissue plasminogen activator (r-TPA), TIA, Hemorrhagic stroke and stroke with stationary course were excluded from the study. The included patients were randomly divided into two groups, group (A) were treated with double antiplatelet aspirin 81 mg plus Clopidogrel 75 mg preceded by the loading dose of both and group (B) were treated with aspirin plus subcutaneous enoxaparin 40 mg (Clexane) once daily for 3 days. After 3 days, both groups continued on double antiplatelet aspirin 81 mg plus Clopidogrel 75 mg.

Results: We found that, at time of discharge 59.3% of group A showed progression in neurological symptoms and remaining 40.7% showed improvement in neurological symptoms while in group B only 13.8% of patients showed progression and remaining 86.2% showed improvement at this time. After one month, 55.56% of group A and 89.66% of group B of patients showed improvement and after 3 months, 66.67% of group A and 89.66% of group B showed improvement with significant difference of the outcome between both groups

Conclusion: We concluded that aspirin plus enoxaparin 40 mg could be superior to aspirin plus Clopidogrel in the early treatment of stroke.

Neuro-Behcet’s-disease (NBD) refers to any neurological involvement of Behcet’s-disease (BD), which is a multisystemic vasculitis, presumably of autoimmune etiology. Few cases of neuropsychiatric manifestation of BD with severe parenchymal lesions have been reported. Clinicians who are unaware of this fact can neglect a fatal complication of BD. With respect to this diagnostic and therapeutic challenge we report of a 38-year-old man with a history of BD, who presented to our emergency department with hyperactive delirium, dysarthria, deterioration of vision, headache and nausea due to pronounced brainstem affection. After symptomatic and causal treatment in our neurological intensive care unit the patient improved clinically, reflected in the decline of pathological findings in the neuroimaging.

Aphasia is a language and communication disorder caused by damage to the brain, usually occurring after stroke or traumatic brain injury. Two MATLAB computer programs are presented for encoding and assessing the sung melodies of stroke patients. The first MATLAB program, Sung Melody to Matrix (SMM.m), converts a patient’s sung melody into a matrix containing the frequency and corresponding duration of each note sung. To find when the patient moves from one note to another, a novel method called Visual Audio Signal Envelope (VASE) is used, which determines an audio signal’s envelope through visual cues. Other existing envelopes that were tested did not work as well with the voice of post-stroke patients recorded in a noisy environment. The second MATLAB program, Melodic Fidelity Evaluator (MFE.m), compares this matrix to the matrix of the tune that the patient was trying to imitate. This second program provides a fair assessment of the note interval error and the time interval error of the patient. In addition, these programs are easy-to-use and can be automated for large data sets to correlate with brain lesions in stroke patients.