Electroconvulsive therapy (ECT) is used to induce therapeutic seizures in various clinical conditions. It is specifically useful in depression, catatonia, patients with high suicidal risk, and those intolerant to drugs. Its beneficial effects surpass its side effects. Memory impairment is benign and transient. Its mechanism of action is unknown, though numerous neurotransmitters and neuroreceptors have been implicated. The standards of ECT practice are well established but still evolving in some particularly in unilateral ECT. Assessment of threshold by formula method may deliver higher stimulus dose compared with titration method. Cerebral seizure during ECT procedure is necessary. Motor (cuff method) and EEG seizure monitoring are mandatory. Recent studies have shown some EEG parameters (amplitude, fractal dimension, symmetry, and post ictal suppression) to be associated with therapeutic outcome. Besides seizure monitoring, measuring other physiological parameters such as heart rate (HR) and blood pressure (BP) may be useful indicators of therapeutic response. Use of ECT in neurological conditions as well as its application in psychiatric illnesses associated with neurological disorders has also been reviewed briefly.

Brucellosis (infection with Brucella sp) is a common zoonotic disease and recently it had been reported from many parts of India. Human brucellosis is a multi system disease that may present with a broad spectrum of clinical manifestations. Involvement of nervous system is rare but is potentially serious and may be affected both in the acute and chronic stages of the disease. It may manifest as meningitis, meningoencephalitis, myelitis, polyradiculoneuropathy, retrobulbar neuritis, papillitis, peripheral and cranial neuritis, cerebrovascular events, spondylosis, polyneuroradiculo-myeloencephalopathy. Gold standard diagnosis certainly requires isolation of organism from blood and make it as investigation of choice. Adequate and early treatment produces very good recovery without neurological deficit in majority of cases. Management requires supportive therapy along with combination of antibiotics including doxycycline, rifampicine, aminoglycosides, contrimoxazole for a period of 8-12 weeks. High degree for suspicion in susceptible individual is very necessary for its diagnosis.

Hot water epilepsy, a reflex epilepsy precipitated by hot water stimulation, has been commonly reported from southern India. Clinical studies have indicated that a phenomenon of hyperthermic kindling may underlie the appearance of spontaneous seizures in some hot water epilepsy patients at a later stage. Our present experiments with a rat model for hot water epilepsy demonstrate the occurrence of slow and fast kindling during hyperthermic seizures, induced by repeated stimulations with hot water, in different populations of rats. These findings have important implications for the pathophysiology and management of this epileptic syndrome in human beings.

Blood pressure changes during squatting and from squatting to standing have been studied in 67 healthy volunteers. A small but significant rise of systolic pressure occurred on squatting (8.09 + 7.04) but not in diastolic pressure (0.99 + 7.38). A very significant drop of systolic pressure occurred on standing from squatting (15.43 + 9.53 mm Hg) compared to the drop recorded on standing from supine position (5.01 + 7.04 mm Hg). Significant drop of lesser magnitude has been recorded in diastolic pressure as well. It appears that recording change in blood pressure from squatting to standing may be a more useful bed side test to assess autonomic function than the usual practice of BP recording on standing from supine position.

A five year old boy manifested with sudden onset of left sided hemiplegia with urinary and fecal incontinence. CT Scan of head revealed evidence of cerebral infarction and magnetic resonance angiography revealed bilateral internal carotid artery stenosis with extensive collateral channels. Ten days later the patient developed typical symptoms of Kluver Bucy syndrome with hyperorality, hypersexuality, loss of memory and hypermetamorphosis. This is the first case report of association of Moya Moya disease with Kluver Bucy Syndrome, Presumably due to involvement of the anterior portion of the limbic system.