Expression Profile of Histone Deacetylases in Patients with Hippocampal Sclerosis

Abstract

Background: Epileptic encephalopathy (EE), associated with ESES, with its associated impact on cognition and language, is an important cause of morbidity in children. The effects of various treatment modalities and the factors affect-ing treatment response are not fully understood. Methods: Case records of patients admitted in the institute and diagnosed to have EE with ESES pattern on EEG were accessed. Spike and wave index (SWI) was calculated from sleep records. Language development was assessed using Receptive-Expressive Emergent Language Scale and seizure outcome using the modified Engel seizure score. Results: Fifty-two children with age ranging from 1 to 19 years were included (idiopathic ESES, n = 19 and symptomatic ESES with pre-existing developmental delay and/or structural brain lesions, n = 33). The two groups differed in terms of younger age at seizure onset in symptomatic ESES ( p = 0.006), early age at language regression ( p = 0.046), history of neonatal seizures ( p = 0.038) and slowing of background on EEG ( p = 0.024). Language regression was noted in 63.5% of the cohort. Twenty-five (48%) patients received steroids alone and showed improvement in seizure ( p ≤ 0.001) and language outcomes at 1 year ( p = 0.021), while 21 (40.3%) received steroids + IVIgG and showed improvement in seizure outcome ( p = 0.002) at 1 year. On 1- year follow-up, seizure remission was noted in 13 (25%) patients with improvement in seizure score in 32/39 (82%) patients and language improvement in 60.8%. Patients with normal background on EEG ( p = 0.03), generalized spikes ( p = 0.05), no Fz negative spikes ( p = 0.01), and SWI < 1.70 ( p = 0.004) were found to have favorable cognitive outcomes on follow-up. 31/45 (68.9%) patients had persistent ESES at 1-year follow-up. ( p = 0.006). In multivariate analysis, ethnic origin, family income, and other socio- economic status were completely associated with treatment acceptance; verbal autopsy find-ings on the nine people who died will be presented. Conclusion: People with epilepsy who do not accept treatment are more likely to be of ethnic origin and from lower income strata. Failure to accept treatment is associated with high mortality. in HS patients, providing a rationale for conducting further exploratory studies. Objective: Long-term treatment by antiepileptic drugs (AEDs) is vital for effective control of seizures in patients with epilepsy ( p WE). The present study was per-formed to measure extent and factors influencing adherence to AEDs. Methods: The present study was a prospective, cross-sectional study, involving PWE reporting at a tertiary care hospital. The extent of adherence to AEDs was measured using Morisky Medication Adherence Scale (MMAS). Data from 451 patients with confirmed diagnosis of epilepsy were subjected to univariate analysis using Chi-square test to observe association between AED adherence and different variables. Further the predictors of adherence were analyzed using binary regression analysis. Results: There were 251 (55.7%) male and 198 (43.9%) female PWE. The extent of adherence to AEDs was high among 326 (72.3%) and low in 125 (27.7%). The socioeconomic status ( p = 0.043) and type of epilepsy ( p = 0.033) were found to be significantly associated with AED adherence. However, no significant difference was observed between adherence and age, gender, marital status, epilepsy duration, number, and type of AEDs, and occurrence of ad-verse drug reactions. Patients with focal epilepsy and those from the middle/lower to middle socioeconomic classes were less likely to be nonadherent. The primary reason for nonad-herence was forgetfulness. Conclusion: Forgetfulness was a primary preven-tive factor for AED nonadherence. We recommend methods to improve the same using multiple measures to maximize adherence and minimize development of pharmaco-resis-tance to AEDs evaluate the anticonvulsant properties rats by pentylenetetrazole ( p TZ)