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Metta V, Dhamija RK, Batzu L, Mrudula R, Kumar NSS, S A, Falup-Pecurariu C, Rodriguez-Blazquez C, Goyal V, L K P, Bhattacharya K, Kumar S, Chaudhuri KR, Borgohain R. Safety and tolerability of long-term apomorphine infusion in advanced Parkinson's disease: an Indian multi-center (APO-IND) experience. Sci Rep 2023; 13:18681. [PMID: 37907679 PMCID: PMC10618227 DOI: 10.1038/s41598-023-46003-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/26/2023] [Indexed: 11/02/2023] Open
Abstract
Advanced Parkinson's Disease (APD) is complicated by the emergence of motor and non-motor fluctuations, which are initially predictable and eventually become unpredictable, in part due to erratic gastric absorption and short half of oral levodopa. Attempts to manage such fluctuations with oral dopaminergic drugs often lead to disabling dyskinesias. Continuous Subcutaneous Apomorphine Infusion (CSAI), despite being approved for the treatment of APD since 1993, was approved in India only in 2019. We studied the safety, tolerability and efficacy of CSAI in Indian patients with APD in a registry design to raise local awareness of this important treatment. We conducted a prospective registry-based observational audit at 10 centers across different states of India. Patients with APD, not responding to or with significant side effects from oral dopaminergic therapy, were assessed at baseline and at month 6 and 12 following CSAI infusion. Fifty-one patients completed the study, CSAI significantly reduced the functional impact of dyskinesia (p < 0.01 at 6 months and p < 0.001 at 12 months). There was a significant improvement in the OFF-state from baseline (p < 0.01 at 6 months and p < 0.001 at 12 months) No discernible side effects were observed apart from mild site reaction (n = 7), nausea (n = 7) skin nodules (n = 2). CSAI demonstrated safety, efficacy, tolerability and improved quality of life in patients with APD, as shown in previous studies. Our study highlighted current existing inequalities in treatment availability, lack of awareness, knowledge gap, affordability and cost remains a concern regarding apomorphine use in Indian PD population.
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Affiliation(s)
- Vinod Metta
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience and Parkinson's Foundation Centre of Excellence, King's College London, King's College Hospital, London, UK.
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, Dubai, United Arab Emirates.
- Parkinson's Foundation Centre of Excellence, King's College Hospital London, London, SE5 9RS, UK.
| | - Rajinder K Dhamija
- Institute of Human Behavior and Allied Sciences, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
| | - Lucia Batzu
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience and Parkinson's Foundation Centre of Excellence, King's College London, King's College Hospital, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, Dubai, United Arab Emirates
| | - Rukmini Mrudula
- Institute of Movement Disorders, Narayana Medical College and Postgraduate Research Centre, Nellore, India
- Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Natuva Sai Sampath Kumar
- Institute of Movement Disorders, Narayana Medical College and Postgraduate Research Centre, Nellore, India
| | - Arunan S
- SRM Institute of Medical Sciences and Technology, Chennai, India
| | | | | | - Vinay Goyal
- Institute of Movement Disorders and Parkinson's Centre, Medanta Hospital, New Delhi, India
| | - Prashanth L K
- Center for Parkinson's Disease and Movement Disorders, Manipal Hospital, Bangalore, India
| | | | - Suresh Kumar
- Amrita Institute of Medical Sciences, Kochi, India
| | - Kallol Ray Chaudhuri
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience and Parkinson's Foundation Centre of Excellence, King's College London, King's College Hospital, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, Dubai, United Arab Emirates
| | - Rupam Borgohain
- Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
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Subramanian M, Velayudham S, Jeyaraj M, Arunan S, Perumal S, Mohan K. A Case of Lance Adams Syndrome in a Patient with Attempted Hanging. Indian J Crit Care Med 2022; 26:1052-1053. [PMID: 36213707 PMCID: PMC9492758 DOI: 10.5005/jp-journals-10071-24299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/13/2019] [Indexed: 12/04/2022] Open
Abstract
Lance Adams syndrome is the term used to describe late post-hypoxic myoclonus. Here we describe a patient who developed action and intention myoclonus after 7 days of attempted partial hanging. The similarity of Lance Adams syndrome, which is a treatable condition to a cerebellar syndrome, and the diagnostic difficulties have been highlighted.
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Affiliation(s)
- Mohanakkannan Subramanian
- Department of Neurology, Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
- Mohanakkannan Subramanian, Department of Neurology, Stanley Medical College and Hospital, Chennai, Tamil Nadu, India, Phone: +91 7358972416, e-mail:
| | - Sakthi Velayudham
- Department of Neurology, Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Malcolm Jeyaraj
- Department of Neurology, Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
| | - S Arunan
- Department of Neurology, Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Sowmini Perumal
- Department of Neurology, Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Kranthi Mohan
- Department of Neurology, Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
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Mallikarjuna SK, Velayutham SS, Sowmini PR, Jeyaraj MK, Arunan S. See-Saw Relationship and its Reversal after Immunotherapy in a Case of Graves' Disease with Coexisting Myasthenia Gravis. J Neurosci Rural Pract 2019; 10:136-138. [PMID: 30765989 PMCID: PMC6337967 DOI: 10.4103/jnrp.jnrp_150_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The unique association of myasthenia gravis (MG) with Graves’ disease in clinical practice emphasizes that one autoimmune disease can coexist with another or many. The relationship between these two entities has remained controversial till date. Some authors have reported a see-saw relationship between these two entities, MG waning with hyperthyroidism and waxing with treatment of hyperthyroidism. Treatment of both these disorders concurrently may be challenging at times as treatment for one entity may worsen the other. The use of beta-blockers and steroids for Graves’ disease may worsen myasthenic weakness. Antithyroid drugs can worsen myasthenia probably by immunomodulatory effects. We report a case of Graves’ disease coexisting with MG in a reciprocal relationship which was subsequently reversed after immunotherapy.
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Affiliation(s)
| | - S Sakthi Velayutham
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
| | - P R Sowmini
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
| | - Malcolm K Jeyaraj
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
| | - S Arunan
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
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Mohanakkannan S, Perumal SR, Velayudham S, Jeyaraj KM, Arunan S. A Case of Morvan's Syndrome Associated with Heavy Metal Poisoning after Ayurvedic Drug Intake. J Neurosci Rural Pract 2019; 9:431-433. [PMID: 30069108 PMCID: PMC6050783 DOI: 10.4103/jnrp.jnrp_555_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Morvan's syndrome is an autoimmune disorder of peripheral and central nervous system mediated by VGKC antibody. Here we report a case of Morvans syndrome who presented 1 month after ayurvedic drug intake. She presented with symptoms of peripheral nerve hyperexcitablity and autoimmune testing revealed positive result for VGKC antibody. Heavy metals level was also significantly raised. She improved after a course of steroids. This case report tries to highlight the association of VGKC mediated Morvans syndrome with heavy metal poisoning and its incidental occurence after Ayurvedic drug intake.
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Affiliation(s)
- S Mohanakkannan
- Department of Neurology, Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Sowmini R Perumal
- Department of Neurology, Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Sakthi Velayudham
- Department of Neurology, Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
| | - K Malcolm Jeyaraj
- Department of Neurology, Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
| | - S Arunan
- Department of Neurology, Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
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