Juvenile myoclonic epilepsy: a study in Sri Lanka.

Juvenile myoclonic epilepsy (JME) has a distinct clinical profile. Often JME is not recognized, with the result that proper treatment is not instituted, leading to poor control of seizures. This study is an attempt to identify the factors that contribute to the delay in diagnosing this condition. During a period of 3 years 40 patients (21 females) with JME were identified and all were included in a prospective follow-up study. The age range was 12-58 years. Twenty-seven patients (67%) had already seen at least one specialist; however, diagnosis had not been made despite the presence of characteristic features. The duration of delay in diagnosis varied from months to years with a mean of 11 years. Myoclonic jerks were the most characteristic feature, but only six volunteered this information spontaneously. The response to treatment with sodium valproate was excellent, although only three were taking it when first seen. As a result of treatment with other drugs all patients were having recurrent seizures. The main reasons for the delay in diagnosis found in our study were that the physicians were unaware of the condition, the occurrence of myoclonic jerks were overlooked either because the patients were not directly questioned about them or because the patients did not volunteer the information.     

High prevalence of eating epilepsy in Sri Lanka

High prevalence of eating epilepsy has previously been reported from the Central Province of Sri Lanka, though it is considered to be a rare condition in the rest of the world. We prospectively studied 526 patients in a different province for seizure provoking factors. Eating epilepsy was found among 28 patients (5.3%) supporting previous observations.     

Knowledge, attitude, and practice of epilepsy in rural Sri Lanka.

Knowledge, attitude, and practice in relation to epilepsy in developing countries appears to be different from that in developed countries. This study was conducted to evaluate knowledge, attitudes, expectations, sociocultural aspects, patient characteristics, disease characteristics, pattern of drug therapy, and outcome of patients with epilepsy in rural Sri Lanka. Data were collected from 207 patients attending an epilepsy clinic. In general the study shows a positive trend in knowledge, expectations and attitude toward epilepsy. Social morbidity is reported from 53.6% indicating that public attitude towards epilepsy needs to be changed. Alternative modes of treatment have been tried by 45.9%, reflecting the cultural beliefs in the society. 75% are on monotherapy and carbamazepine is the most commonly used drug. Seizure control is excellent (no seizures during the preceding 6 months) in 33.8%. Side effects of antiepileptic drugs are reported by 76.3%. Various kinds of medical morbidity have been experienced by 32.9% of patients.     

Behavior therapy in Sri Lanka

The development of behavior therapy in Sri Lanka is presented. Its beginnings in the decade of the 70s in the two medical schools in Colombo and Peradeniya and its current status are reviewed, and future prospects are discussed. The need for developing and expanding behavior therapy practice in the country, and possible directions in training, are commented on.     

Simplification of antiepileptic pharmacotherapy: from the viewpoint of rational management for epilepsy

Rational management for epilepsy was investigated mainly from the viewpoint of antiepileptic pharmacotherapy. At first, diagnoses were reviewed by the ILAE classification for epilepsies and epileptic syndromes in 603 patients who visited a newly-established outpatient clinic for epilepsy and problems concerning the diagnosis of epilepsy were pointed out. Then, habitual pharmacotherapy in the past was assessed critically in cases where details of treatment before hospital attendance could be known. Further, the results of prospectively conducted simplification of pharmacotherapy where the appropriate choice of drugs and dosage were taken into account were reported. Furthermore, questions about the conventional criteria for drug effect evaluation were described and new criteria through which the influence on the daily life was also evaluated were presented. Finally, from the standpoint of comprehensive treatment, the system of rational management was discussed.     

Suicide in a northern town of Sri Lanka

ABSTRACT– Suicide mortality in a northern town of Sri Lanka for the year 1982 is examined. The rate was 53.5 per 100,000 general population and shows an increasing trend amongst the 15–34 age group. The commonest method was self-poisoning by agrochemicals and insecticides of organophosphorus type. Psychiatric diagnosis, social, economic and political factors are presented. Easy availability of dangerous agrochemicals and rapid social and political changes appear to be of equal importance in producing a high rate of suicide.     

Psychological intervention with displaced widows in Sri Lanka

This paper describes a programme for war widows residing in refugee camps in Sri Lanka.The country has been traumatized by civil conflict for over 15 years and one in seventeen people have been displaced.The explicit aim of the programme is to promote mental health among the refugees, mainly by facilitating coping strategies. Self-help principles are utilized.An additional aim of the programme is to help foster relationships between women from the different sides of the conflict, thereby providing an opportunity for changing perceptions, attitudes and stereotyped beliefs. A blend of traditional models based on expert knowledge and a more radical model, which maximizes the resources of the women themselves, is used.The cultural and socio-political issues defining the intervention at micro- and macro-levels are also discussed.     

Possession trance in a semi-urban community in Sri Lanka.

A survey of possession trance states in a semi-urban population of 7653 identified 37 subjects. The manifestations of the trance, and its course and outcome are outlined. The characteristics of the subjects, including presence of psychiatric disorder, are compared with that of the total population, and significant differences are noted. Four psychodynamic syndromes observed are described with illustrative case vignettes. The functions subserved by possession behaviour are reviewed, and comparisons are drawn between personal possession, ritual possession, and altered states of consciousness in Western society.     

Epidemiological study of epilepsy from a tertiary care hospital in kingdom of Saudi Arabia

Objectives:To identify the types of seizures and describe the clinical features, EEG and radiological findings among patients with epilepsy.Methods:In this retrospective epidemiological study, we analyzed the medical records of the patients with the diagnosis of epilepsy during the study period (January 1st 2016- December 2016)Results:The study included 184 patients, 91 (49.5%) were males and 93 (50.5%) females. Age ranged between 12 and 85 years (mean 35.4±19.5 SD years). Most of the patients 150 (82%) had Generalized tonic clonic seizures followed by focal onset in 27 (14%) of the patients. Main EEG abnormality was focal to bilateral was recorded in 53 (41%), idiopathic/ cryptogenic epilepsy was diagnosed in 61% of the patients. The most common abnormalities on brain imaging were temporal/hippocampal atrophy/stroke. The most common cause of symptomatic epilepsy was stroke found in 20(11%) followed by post infectious epilepsy and head trauma.Conclusion:Seizure types, EEG characteristics and etiologies of symptomatic epilepsy in our cohort of patients are in accordance with the current literature. Slight discrepancy observed in gender distribution and etiologies for symptomatic epilepsy compared with other studies from Saudi Arabia need to be studied further by prospective and population base studies.

Epilepsy is one of the most common neurological diseases and is a serious neurological disorder that is associated with social stigma.1 Epilepsy can be defined as a brain disorder that is characterized by episodes of vigorous shaking and disturbed brain activity (seizures) that can affect the patient’s attention and behavior.2 According to World Health Organization 2010 Global burden of Disease Study, it is the second most neurological disorder around the world in terms of disability adjusted life years.3 According to one of the prevalence study available from the kingdom of Saudi Arabia in 2001, the prevalence of epilepsy was found to be 6.54 per 10004 and in other Arab countries (Sudan, Libya and Tunisia) was about 2.3/1000.5 The incidence of epilepsy has been found to be substantially greater in developing countries compared with developed countries.6 Epidemiological studies about epilepsy from Arab countries especially Saudi Arabia are lacking. We were able to find only few studies about the prevalence of seizure disorder in an Arab population5,7 and even sparser from Saudi Arabia.4,8 we were unable to find any study regarding epidemiology of Epilepsy from our hospital. This study therefore was aimed to review and present the data of patients with epilepsy from our hospital, King Fahd Hospital of the University (KFHU), Alkhobar, Kingdom of Saudi Arabia.     

After the tsunami: a story from Sri Lanka

Children and adolescents are one of the very vulnerable groups in any disaster situation. Not only did around 10,000 children die in the tsunami in Sri Lanka, but the survivors experienced a number of symptoms. Children and adolescents were often not allowed to grieve, as information on their parents' and family members' deaths were withheld from them in order to protect them. Fear of recurrence and separation anxiety was related to school refusal. In addition, displacement and within-country migration led to increased demands and pressure on extended family and in some cases led to child sexual abuse. In this paper, lessons from observation of the aftermath of the disaster are described. For health care professionals as well as for lay volunteers, some factors have to be contextualized within the cultural context.     

Survey of psychiatric morbidity in a semi-urban population in Sri Lanka

This paper reports a survey of psychiatric morbidity in a semiurban community (population 7,653) in Sri Lanka. The entire population was first screened by social workers using a standardized interview. Probable cases were then examined by psychiatrists. Each psychiatric disorder identified was rated on four different parameters of severity, and only those rating moderate or severe were labelled as cases. The socio-demographic characteristics of the cases and the population at risk, and the frequency and nature of psychiatric disorders are presented in Tables. The 6-month period prevalence for all psychiatric disorders was 45.5 per 1,000, with psychoses amounting to 6.9 (males 5.5; females 8.4) per 1,000, and neuroses to 25.2 (males 9.9; females 40.6) per 1,000. The large majority of disorders were chronic and had not received psychiatric treatment. The relevance of these surveys in the provision of psychiatric services in developing countries is discussed.     

Predicting antiepileptic drug response in children with epilepsy

In clinical practice, after diagnosis and when treatment has begun, it is important to predict as soon as possible which children will become seizure-free and which are likely to develop medically intractable seizures. This article summarizes factors predicting seizure remission in childhood-onset epilepsy treated with antiepileptic drugs (AEDs). Sustained seizure remission can be expected in over 90% of idiopathic epilepsies of childhood and in neurologically normal children with epilepsy having infrequent seizures showing early remission after starting treatment with AEDs. Even in the presence of symptomatic etiology of epilepsy--focal seizures and syndromes; high seizure frequency prior to or during treatment; seizure clustering; and poor or delayed response to first adequate drug therapy--up to 60% of children with treated epilepsy are able to enter long-term remission. However, remission can be expected in only 30% or less of those with catastrophic epilepsies of childhood.     

Pediatric experience with sudden unexplained death in epilepsy at a tertiary epilepsy center

Sudden unexplained death in epilepsy is rare in children, and few studies report risk factors. We reviewed our experience with 17 cases of sudden unexplained death in epilepsy to determine risk factors in children. The charts of all patients with onset of epilepsy at less than age 18 years who suffered sudden unexplained death in epilepsy between August 1992 and April 2004 at our epilepsy center were retrospectively reviewed. Deaths were classified as possible, probable, or definite sudden unexplained death in epilepsy. There were seven cases of definite, nine cases of probable, and one case of possible sudden unexplained death in epilepsy. Generalized tonic-clonic seizures and prone position during sleep were found to be major risk factors. Sudden unexplained death in epilepsy in children and adolescents is associated with convulsive seizures, and aggressive treatment of nocturnal generalized tonic-clonic seizures might help lower the occurrence.     

Collective trauma in northern Sri Lanka: a qualitative psychosocial-ecological study

Background  

Complex situations that follow war and natural disasters have a psychosocial impact on not only the individual but also on the family, community and society. Just as the mental health effects on the individual psyche can result in non pathological distress as well as a variety of psychiatric disorders; massive and widespread trauma and loss can impact on family and social processes causing changes at the family, community and societal levels.