WCIM 2014 SEOUL KOREA 83
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0144 Neurology
Estimating Effi cacy of Active Hexose Correlated Com- pound as Immune Therapy for Patients Diagnosed with Pharmacoresistant Epilepsy
Natalia MIKHAILICHENKO1, Viacheslav KULAGIN2
Nevron International Medical Center, Russia1, Nevron International Medical Center, Russia2
Background: examination of clinical neuroimmune disorders of patients diagnosed with pharmacoresistant epilepsy, to estimate immune role in pathogenesis of the disease and effi cacy of immune therapy, Active Hexose Correlated Compound (AHCC) supplement, in particular.
Methods: several children with unmoderate verifi ed resistant epilepsy were examined with clinico-paraclinic Methods: Immunologic methods included prelaboratory examina- tion aimed at revealing clinical syndromes of secondary immunodefi ciency and labora- tory examination with the purpose to identify multiple defects in the immune system.
Immunologic examination was performed according to standard Methods: In order to determine immune status there were measured quantitative and functional indicators: 1) percentage of T- and B- lymphocytes in peripheral blood (total number of lymphocytes, percentage and absolute number of mature T-cells – CD3+, two basic subpopulations – helpers CD4+ and killers-suppressors CD8+; В-lymphocytes – CD20+; immunoregu- latory balance – balance between CD4+ and CD8+; 2) concentration of serum immuno- globulin А, G, М (IgА, IgG, IgМ). All patients received combined treatment including baseline antiepileptic and immune therapy АНСС –2 i.d. during one month.
Results: after AHCC intake patients had positive quantity changes of peripheral t-cell pool (CD3+), Т-helpers amount increase (CD4+) and 1,4 times more increase of T-sup- pressors/killers (CD8+-lymphocytes). Due to CD4+ lymphocytes subset, current changes moved up immunoregulatory balance (CD4+/CD8+). 35% of clinical changes displayed frequency and intensity reduction of epileptic seizures, other patients had somatic health status and physiological functions improved.
Conclusions: Mentioned before data demonstrate that patients with resistant epilepsy have signifi cant neuroimmune disorders. АНСС Immunotherapy improves immune status by increasing amount of Т-lymphocytes, regulate subset balance, activates phagocytes and humoral function. In addition, it decreases neuroimmunization by regu- lating amount of serum immunoglobulins. Such effect indicates reverse of autoimmune process which has pathobiological signifi cance in epileptogenesis.
PS 0145 Neurology
Stroke Risk and Outcomes in Patients with Epilepsy:
Two Nationwide Studies
Chien-Chang LIAO1, Ta-Liang CHEN1 Taipei Medical University, Taiwan R.O.C1
Background: The association between epilepsy and stroke was not completely under- stood. The purpose of this study is to investigate whether patients with epilepsy have an increased risk of stroke or post-stroke mortality.
Methods: Using Taiwan’s National Health Insurance Research Database, we conduct- ed a retrospective cohort study of 3,284 patients with new-diagnozed epilepsy and 13,136 persons without epilepsy between 2000 and 2004. The risk of stroke was com- pared between 2 cohorts through December 31, 2008. To investigate the association between in-hospital mortality after stroke and history of epilepsy, we conducted a case-control study of 135,220 hospitalized patients with newly diagnosed stroke be- tween January 1, 2005, and December 31, 2008. The post-stroke in-hospital mortality and complications were compared between stroke patients with and without previous epilepsy.
Results: The epilpesy cohort had an increased stroke risk (hazard ratio [HR] 2.18; 95%
CI 1.87-2.54). Among patients with stroke, those with a history of epilepsy had a high- er risk of post-stroke mortality compared withthose without epilepsy (odds ratio 1.26;
95% CI 1.17-1.36). Epilepsy was also associated with post-stroke pneumonia (odds ra- tio 1.52; 95% CI 1.44-1.62) and urinary tract infection (odds ratio 1.48; 95% CI 1.39- 1.56). The association between epilepsy and stroke risk remains signifi cant in every age group (20-39, 40-49, 50-59, 60-69, >=70) and both sexes.
Conclusions: Epilepsy was associated with risk of stroke and post-stroke pneumonia, urinary tract infection and mortality. This research shows the importance of preven- tion, early recognition, and treatment of stroke in epileptic population.
PS 0146 Neurology
Memory Impairment in Young Diabetic Males: An Alarming Concern!
Parul KODAN1, Jayakumar J1, Seemanthani T.S.1, Sydney DSOUJA1 Kasturba Medical College, India1
Background: With diabetes rapidly affecting even the younger population makes it alarming for the physicians to understand its various complications. Although the effects of DM on peripheral nervous system are well established, the effects of Dia- betes(DM) on CNS have been less clear. Even a modest effect on cognitive function will have signifi cant public health implications. Our study is one of the unique study from Indian subcontinent where we aimed to compare the memory profi le of 30-55 years old men with Type II DM with age matched controls and to fi nd whether any relationship exists between DM control and memory function in this age group.
Methods: The study design was a cross sectional clinical study of Diabetic males of age group 30-55 years and age matched controls for memory testing. The study included men of 30-55 years diagnosed to have Type 2 DM.All patients with previous neurological disorders or hypothyroidism were excluded. All patients,after valid con- sent, were tested for memory testing using PGI Memory Scale. Test was objectively scored scores and ranged from 0-100.All patients with Diabetes were also tested for HbA1c.
Results: Average memory score in case group was 80.76±8.75 and it was 87.68±7.39 in control group which was statistically signifi cant showing better memory scoring in control group. When long term diabetes control was compared it was seen that there is a trend of higher HbA1c having poor memory scoring.
Conclusions: Our study showed presence of mild cognitive impairment in young males with diabetes which is an alarming revelation. This pathbreaking fi nding is an alarm- ing indication to the clinicians and neurologist to look for this complication in young patients of diabetes. Also our study showed trend of higher HbA1c had poor memory scoring underscoring the importance of strict diabetes control especially in young dia- betes.
PS 0147 Neurology
Confusion after “Chasing the Dragon”: A Case of De- layed Toxic Leukoencephalopathy
Alana NEVARES1, Jorge MORALES1, Nikhil CHADHA1, James DORMAN2 John Stroger Hospital of Cook County, USA1, John Stroger Hospital of Cook County, USA2
Toxic Leukoencephalopathy refers to a spectrum of leukoencephalopathies caused by iatrogenic, drug, hypoxic or infectious insults to the white matter. “Chasing the Drag- on” refers to the inhalation of heated heroin fumes.
Case presentation: A 31 year old gentleman with no past medical history after loss of consciousness followed by unresponsiveness for 3 hours, after his fi rst time of having
“chased the dragon”, was admitted to ICU with respiratory failure requiring mechanical ventilation, recovered and returned to normal functioning within one week. Behavior was at his baseline for 2 weeks after discharge, followed by sudden onset odd behav- ior. On exam he was alert, but apathetic; he was mute with inappropriate smiling and following simple commands. He had functional urinary-fecal incontinence, symmetric hyperrefl exia in lower extremities and upgoing toes. HIV, syphilis, b12 defi ciency, high sedimentation rate were ruled out. Cerebrospinal fl uid showed elevated protein level.
Electroencephalogram showed diffuse slowing. Magnetic resonance imaging (MRI) showed diffuse bilateral cerebral periventricular and deep and subcortical white matter high T2/FLAIR signal intensities. At 5-weeks follow up, he was talkative and coherent, with adequate affect. Cognitive Linguistic Quick Test 8-weeks after discharge, demon- strated mild attention, moderate memory and severe executive functions impairment, normal language and moderate Clock Drawing Severity Rating.
Discussion: Post-hypoxic and “Chasing the Dragon” leukoencephalopathies are among the unique causes of delayed-onset toxic leukoencephalopathies. Onset usually occurs 1-3 weeks after the insult as in this patient, who developed the akinetic-mutism form of DPHL and lacked the primarily cerebellar/ataxic syndrome typical of HL. MRI fi nd- ings were diffuse and lacked the predominantly posterior and cerebellar distribution of HL, supporting the diagnosis of DPHL. As in our patient, most people with DPHL will improve within 3 to 12 months, but impaired attention and executive functions usual- ly persist.
