Objective The COVID-19 pandemic impacted the care of people with epilepsy (PWE). Several online surveys were conducted but there is limited data regarding the impact on low-income PWE from lower-middle income countries (LMICs) who have no access or ability to answer online surveys. The purpose of this interview was to understand the challenges faced by low-income PWE during the lockdown phase of the pandemic. Method PWE visiting the epilepsy specialty outpatient department of a tertiary referral government hospital to avail of subsidized services were interviewed. In the interview, they discussed challenges in obtaining medical care, the impact on wellbeing, employment, and vaccination status during the lockdown phase of the pandemic. Results Out of the 214 PWE interviewed, 20.6% had increased seizure frequency, 28.9% did not have access to medication mainly due to travel restrictions, 30.5% reported lack of availability of medication and 50% were not able to afford the medication mainly due to loss of income. 51% were unable to have follow-up consultations. 36% reported worsening of mood and some reported impact on other aspects of wellbeing. The impact on wellbeing was significantly associated with an increase in seizure frequency (P < .05). The study revealed hesitation related to vaccines in the majority and expectations of financial support by the government and assistance for procuring medication. There was a lack of awareness about telemedicine services and the same was not adequately offered by government hospitals. Significance The study underscores the need to learn lessons from the challenging experiences of low-income PWE and create an action plan for the future to address the issues of lack of affordability of medical care and access to telemedicine. It is critical that the care of the marginalized, underrepresented PWE from lower-middle income countries is not neglected during a pandemic.

Background: Autoimmune encephalitis (AE) can be a disabling condition, but it is manageable when identified in its early phases. Multiple diagnostic modalities can aid the diagnosis and delineation of areas of involvement in the brain, which is essential in correlating the symptoms to their pathology. Case presentation: This case series focuses on three cases of anti-LGI1 encephalitis in their 3rd and 5th decades, each displaying facio-brachial dystonic seizures (FBDS) and varying symptoms, such as behavioural changes and hyperhidrosis. Their MRI brains were not conclusive, but when the patients underwent a PET scan, all three of them showed involvement of the Basal Ganglia, which reversed along with clinical improvement after standard treatment for AE. Conclusions: AE can be a morbid condition for a long time, but some factors that might predispose to better patient outcomes might be early diagnosis and treatment. A PET scan is a modality that might help pick up functional changes before structural changes set in, and so should be considered in the diagnostic workup. Patterns of involvement of brain areas in Anti LGI1 AE need delineation, and basal ganglia seems to be a consistent region of involvement.

People referred to First Seizure Clinics (FSCs) often face long waiting times. Many have seizure mimics. This study aimed to evaluate the impact of an epilepsy nurse (EN) in reducing wait times and minimising seizure mimic referrals. We also aimed to illustrate the range of seizure mimics referred to the FSC and describe diagnostic revisions over time. We prospectively collected data from 100 consecutive individuals seen in FSCs at our centre before and after the introduction of a new part-time EN. We followed up for a minimum of 12 months. Key outcomes included diagnostic revisions over time, changes in referral patterns, characteristics of seizure mimics, and time elapsed between referral and FSC appointment. Patients (50 male, 50 female) had a median age of 41.4 years (range 18-90 years). Fifteen (15%) people had an abnormal MRI, and 33% had an abnormal EEG, including eleven (11%) with epileptiform abnormalities. Seizure mimics accounted for 29/50 (58%) diagnoses before the commencement of an epilepsy nurse and reduced to 19/50 (38%) after the commencement of an epilepsy nurse (p < 0.05). There was no significant reduction in clinic wait time post-EN (relative reduction in median wait time of 39%, p = 0.41). Common seizure mimics included syncope (18%) and Non-Epileptic Events (8%). Twelve people (8 pre-EN, 4 post-EN) had a diagnostic change to Epilepsy over the next 12 months after FSC. An epilepsy nurse was associated with a reduction in the frequency of seizure mimics seen in our FSC. Further research is needed to investigate the impact of epilepsy nurses on the performance of FSCs.