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Bajaj J, Chandra SP, Ramanujam B, Subianto H, Girishan S, Doddamani R, Agrawal M, Samala R, Dwivedi R, Chaudhary K, Garg A, Tripathi M, Bal CS, Nehra A, Sharma MC, Tripathi M. Comparative Analysis of Hemispherotomy in Adults versus Children- A Prospective Observational Series. Neurol India 2024; 72:69-73. [PMID: 38443004 DOI: 10.4103/neuroindia.ni_299_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/06/2020] [Indexed: 03/07/2024]
Abstract
BACKGROUND Hemispherotomy (HS) is an effective treatment for unilateral hemispheric onset epilepsy. There are few publications for HS in adults, and there is no series comparing adults and pediatric patients of HS. OBJECTIVE To compare the hemispherotomies done in adult patients with pediatric ones in terms of efficacy and safety. METHODS Data was prospectively collected for HS patients (up to 18 years and more) from Aug 2014 to Aug 2018. Comparison between the groups was made for seizure onset, duration of epilepsy, frequency of seizures, number of drugs, intraoperative blood loss, postoperative seizure control, postoperative stay, postoperative motor functions, and preoperative and postoperative intelligence quotient. Follow-up was one year. RESULTS A total of 61 pediatric and 11 adults underwent HS. The seizure onset was earlier in children, and the duration of epilepsy was longer in adults. The frequency of seizures per day was more in children being 14.62 ± 26.34 in children, and 7.71 ± 5.21 per day in adults (P - 0.49). The mean number of drugs was similar in the preoperative and postoperative periods in both. Class I seizure outcome was similar in both the groups being 85.24% in children and 90.9% in adults (P - 0.56). Blood loss, postoperative stay, was similar in both the groups. No patient had a new permanent motor deficit. Power worsened transiently in 1 pediatric patient and in 4 adult patients. The visual word reading and object naming improved in both the groups (no intergroup difference), and IQ remained the same in both groups. One adult patient had meningitis, and another had hydrocephalus requiring shunt placement. CONCLUSION Hemispherotomy is a safe and effective procedure in adults as in children in appropriately selected patients.
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Affiliation(s)
- Jitin Bajaj
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Sarat P Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Bhargavi Ramanujam
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Heri Subianto
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shabari Girishan
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Doddamani
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Raghu Samala
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rekha Dwivedi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Chaudhary
- Department of Biomedical Engineering/NMR, IIT/AIIMS, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - C S Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashima Nehra
- Department of Neuropsychology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar C Sharma
- Department of Neuropathology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Kaur K, Sharma G, Dwivedi R, Nehra A, Parajuli N, Upadhyay AD, Deepak KK, Jat MS, Ramanujam B, Sagar R, Mohanty S, Tripathi M. Effectiveness of Yoga Intervention in Reducing Felt Stigma in Adults With Epilepsy: A Randomized Controlled Trial. Neurology 2023; 101:e2388-e2400. [PMID: 37940550 PMCID: PMC10752634 DOI: 10.1212/wnl.0000000000207944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/28/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Persons with epilepsy are afflicted with comorbidities such as stigma, anxiety, and depression which have a significant impact on their quality of life. These comorbidities remain largely unaddressed in resource-limited countries. This randomized controlled trial (RCT) aimed to investigate whether yoga and psychoeducation were effective in reducing felt stigma (primary outcome), neuropsychiatric outcomes, and seizure frequency, as compared with sham yoga and psychoeducation in persons with epilepsy. METHODS This was an assessor-blinded, sham yoga-controlled RCT. Patients clinically diagnosed with epilepsy, aged 18-60 years, and scoring higher than the cutoff score for felt stigma as measured by the Kilifi Stigma Scale (KSS) in our population were randomly assigned to receive either yoga therapy plus psychoeducation (intervention) or sham yoga therapy plus psychoeducation (comparator) for a duration of 3 months. The primary outcome was a significant decrease in felt stigma as compared with the comparator arm as measured by the KSS. Primary and secondary outcomes (seizure frequency, quality of life, anxiety, depression, mindfulness, trait rumination, cognitive impairment, emotion regulation) were assessed at baseline, 3 months, and 6 months. Parametric/nonparametric analysis of covariance and the χ2 test were used to compare the 2 arms. RESULTS A total of 160 patients were enrolled in the trial. At the end of the follow-up period (6 months), the intervention arm reported significant reduction in felt stigma as compared with the control arm (Cohen's d = 0.23, 95% CI -0.08 to 0.55, p = 0.006). Significantly higher odds of >50% seizure reduction (odds ratio [OR] 4.11, 95% CI 1.34-14.69, p = 0.01) and complete seizure remission (OR 7.4, 95% CI 1.75-55.89, p = 0.005) were also observed in the intervention group. The intervention group showed significant improvement in symptoms of anxiety, cognitive impairment, mindfulness, and quality of life relative to the control group at the end of follow-up period (p < 0.05). DISCUSSION Yoga can alleviate the burden of epilepsy and improve the overall quality of life in epilepsy by reducing perceived stigma. TRIAL REGISTRATION INFORMATION Clinical Trials Registry of India (CTRI/2017/04/008385). CLASSIFICATION OF EVIDENCE This study provides Class I evidence that yoga reduces felt stigma in adult patients with epilepsy.
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Affiliation(s)
- Kirandeep Kaur
- From the Department of Neurology (K.K., R.D., B.R., M.T.), All India Institute of Medical Sciences, New Delhi; MEG Resource Facility (K.K.), National Brain Research Institute, Manesar; Centre for Integrative Medicine and Research (G.S., N.P., M.S.J., S.M.), Department of Cardiology (G.S.), Department of Neuropsychology (A.N.), Department of Biostatistics (A.D.U.), Department of Physiology (K.K.D.), and Department of Psychiatry (R.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Gautam Sharma
- From the Department of Neurology (K.K., R.D., B.R., M.T.), All India Institute of Medical Sciences, New Delhi; MEG Resource Facility (K.K.), National Brain Research Institute, Manesar; Centre for Integrative Medicine and Research (G.S., N.P., M.S.J., S.M.), Department of Cardiology (G.S.), Department of Neuropsychology (A.N.), Department of Biostatistics (A.D.U.), Department of Physiology (K.K.D.), and Department of Psychiatry (R.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Rekha Dwivedi
- From the Department of Neurology (K.K., R.D., B.R., M.T.), All India Institute of Medical Sciences, New Delhi; MEG Resource Facility (K.K.), National Brain Research Institute, Manesar; Centre for Integrative Medicine and Research (G.S., N.P., M.S.J., S.M.), Department of Cardiology (G.S.), Department of Neuropsychology (A.N.), Department of Biostatistics (A.D.U.), Department of Physiology (K.K.D.), and Department of Psychiatry (R.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Ashima Nehra
- From the Department of Neurology (K.K., R.D., B.R., M.T.), All India Institute of Medical Sciences, New Delhi; MEG Resource Facility (K.K.), National Brain Research Institute, Manesar; Centre for Integrative Medicine and Research (G.S., N.P., M.S.J., S.M.), Department of Cardiology (G.S.), Department of Neuropsychology (A.N.), Department of Biostatistics (A.D.U.), Department of Physiology (K.K.D.), and Department of Psychiatry (R.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Niranjan Parajuli
- From the Department of Neurology (K.K., R.D., B.R., M.T.), All India Institute of Medical Sciences, New Delhi; MEG Resource Facility (K.K.), National Brain Research Institute, Manesar; Centre for Integrative Medicine and Research (G.S., N.P., M.S.J., S.M.), Department of Cardiology (G.S.), Department of Neuropsychology (A.N.), Department of Biostatistics (A.D.U.), Department of Physiology (K.K.D.), and Department of Psychiatry (R.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Ashish D Upadhyay
- From the Department of Neurology (K.K., R.D., B.R., M.T.), All India Institute of Medical Sciences, New Delhi; MEG Resource Facility (K.K.), National Brain Research Institute, Manesar; Centre for Integrative Medicine and Research (G.S., N.P., M.S.J., S.M.), Department of Cardiology (G.S.), Department of Neuropsychology (A.N.), Department of Biostatistics (A.D.U.), Department of Physiology (K.K.D.), and Department of Psychiatry (R.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Kishore K Deepak
- From the Department of Neurology (K.K., R.D., B.R., M.T.), All India Institute of Medical Sciences, New Delhi; MEG Resource Facility (K.K.), National Brain Research Institute, Manesar; Centre for Integrative Medicine and Research (G.S., N.P., M.S.J., S.M.), Department of Cardiology (G.S.), Department of Neuropsychology (A.N.), Department of Biostatistics (A.D.U.), Department of Physiology (K.K.D.), and Department of Psychiatry (R.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Man S Jat
- From the Department of Neurology (K.K., R.D., B.R., M.T.), All India Institute of Medical Sciences, New Delhi; MEG Resource Facility (K.K.), National Brain Research Institute, Manesar; Centre for Integrative Medicine and Research (G.S., N.P., M.S.J., S.M.), Department of Cardiology (G.S.), Department of Neuropsychology (A.N.), Department of Biostatistics (A.D.U.), Department of Physiology (K.K.D.), and Department of Psychiatry (R.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Bhargavi Ramanujam
- From the Department of Neurology (K.K., R.D., B.R., M.T.), All India Institute of Medical Sciences, New Delhi; MEG Resource Facility (K.K.), National Brain Research Institute, Manesar; Centre for Integrative Medicine and Research (G.S., N.P., M.S.J., S.M.), Department of Cardiology (G.S.), Department of Neuropsychology (A.N.), Department of Biostatistics (A.D.U.), Department of Physiology (K.K.D.), and Department of Psychiatry (R.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sagar
- From the Department of Neurology (K.K., R.D., B.R., M.T.), All India Institute of Medical Sciences, New Delhi; MEG Resource Facility (K.K.), National Brain Research Institute, Manesar; Centre for Integrative Medicine and Research (G.S., N.P., M.S.J., S.M.), Department of Cardiology (G.S.), Department of Neuropsychology (A.N.), Department of Biostatistics (A.D.U.), Department of Physiology (K.K.D.), and Department of Psychiatry (R.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Sriloy Mohanty
- From the Department of Neurology (K.K., R.D., B.R., M.T.), All India Institute of Medical Sciences, New Delhi; MEG Resource Facility (K.K.), National Brain Research Institute, Manesar; Centre for Integrative Medicine and Research (G.S., N.P., M.S.J., S.M.), Department of Cardiology (G.S.), Department of Neuropsychology (A.N.), Department of Biostatistics (A.D.U.), Department of Physiology (K.K.D.), and Department of Psychiatry (R.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- From the Department of Neurology (K.K., R.D., B.R., M.T.), All India Institute of Medical Sciences, New Delhi; MEG Resource Facility (K.K.), National Brain Research Institute, Manesar; Centre for Integrative Medicine and Research (G.S., N.P., M.S.J., S.M.), Department of Cardiology (G.S.), Department of Neuropsychology (A.N.), Department of Biostatistics (A.D.U.), Department of Physiology (K.K.D.), and Department of Psychiatry (R.S.), All India Institute of Medical Sciences, New Delhi, India.
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Tayade K, Vibha D, Singh RK, Pandit AK, Ramanujam B, Das A, Elavarasi A, Agarwal A, Srivastava AK, Tripathi M. Prevalence and determinants of post-stroke sleep disorders: a cross-sectional hospital-based study. Sleep Breath 2023; 27:2429-2433. [PMID: 37183196 DOI: 10.1007/s11325-023-02850-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/22/2023] [Revised: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Post-stroke sleep disorders (PSSD) are an important part of post-stroke disability. PSSD is neglected as a part of stroke rehabilitation. We aimed to study the prevalence and determinants of PSSD in a hospital based, single center setting. METHODS In a cross-sectional study, adult patients (≥ 18 years) with stroke (one month to one year after the onset), were enrolled in the study. Demographic, clinical, radiological, and motor and functional disabilities were assessed. Sleep quality was assessed with Pittsburg Sleep Quality Index (PSQI) and STOP BANG questionnaire (for obstructive sleep apnea [OSA]). Patients with poor sleep quality (PSQI > 5) were analyzed for risk factors. RESULTS A total of 103 patients were recruited in the study period (January 2021 to June 2022). The self-reported prevalence of PSSD was 16% which increased to 72% when the PSQI was administered. High risk of OSA was present in 33%. In bivariate analysis, factors associated with PSQI > 5 were involvement of ≥ 2 lobes, lower body mass index (BMI), worse modified Rankin Scale (mRS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Stroke Specific Quality of Life (SSQoL). In multivariate analysis, only depression was associated with PSQI > 5 (OR: 1.3 (1.0; 1.7); p-value = 0.03). CONCLUSION PSSD had a prevalence of 72%. In multivariate analysis, the factor associated with PSQI > 5 was worse HAM-D score.
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Affiliation(s)
- Kamalesh Tayade
- Neurosciences Center, Department of Neurology, All India Institute of Medical Sciences, Room number 707, 7th Floor, New Delhi, India
| | - Deepti Vibha
- Neurosciences Center, Department of Neurology, All India Institute of Medical Sciences, Room number 707, 7th Floor, New Delhi, India.
| | - Rajesh Kumar Singh
- Neurosciences Center, Department of Neurology, All India Institute of Medical Sciences, Room number 707, 7th Floor, New Delhi, India
| | - Awadh Kishor Pandit
- Neurosciences Center, Department of Neurology, All India Institute of Medical Sciences, Room number 707, 7th Floor, New Delhi, India
| | - Bhargavi Ramanujam
- Neurosciences Center, Department of Neurology, All India Institute of Medical Sciences, Room number 707, 7th Floor, New Delhi, India
| | - Animesh Das
- Neurosciences Center, Department of Neurology, All India Institute of Medical Sciences, Room number 707, 7th Floor, New Delhi, India
| | - Arunmozhimaran Elavarasi
- Neurosciences Center, Department of Neurology, All India Institute of Medical Sciences, Room number 707, 7th Floor, New Delhi, India
| | - Ayush Agarwal
- Neurosciences Center, Department of Neurology, All India Institute of Medical Sciences, Room number 707, 7th Floor, New Delhi, India
| | - Achal Kumar Srivastava
- Neurosciences Center, Department of Neurology, All India Institute of Medical Sciences, Room number 707, 7th Floor, New Delhi, India
| | - Manjari Tripathi
- Neurosciences Center, Department of Neurology, All India Institute of Medical Sciences, Room number 707, 7th Floor, New Delhi, India
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Singh V, Grewal KS, Vibha D, Singh RK, Ramanujam B, Nehra A, Chandra SP, Gaikwad S, Babu I, Tripathi M. Cortico-limbic disruption, material-specificity, and deficits in cognitive-affective theory of mind. Brain Commun 2023; 5:fcad100. [PMID: 37101833 PMCID: PMC10123397 DOI: 10.1093/braincomms/fcad100] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 12/20/2022] [Accepted: 04/18/2023] [Indexed: 04/28/2023] Open
Abstract
The Theory of Mind deficit due to cognitive-affective disintegration is a poorly understood cognitive consequence of cortical and subcortical disruption in right temporal lobe epilepsy. Following Marr's trilevel approach, we used the material-specific processing model to understand the Theory of Mind deficit in drug-resistant epilepsy (N = 30). We examined pre- and post-surgery changes in first-order (somatic-affective, non-verbal component) and second-order Theory of Mind (cognitive-verbal component) in three groups formed using: (i) seizure side (right versus left), (ii) right temporal epilepsy (right temporal lobe epilepsy versus non-right temporal lobe epilepsy), and (iii) right temporal lobe epilepsy with amygdalohippocampectomy (right temporal lobe epilepsy versus left temporal lobe epilepsy amygdalohippocampectomy versus non-amygdalohippocampectomy). We observed a marked deficit in the first-order Theory of Mind in the right temporal lobe amygdalohippocampectomy group; we mapped this deficit to decline in the non-verbal component of Theory of Mind (somatic-affective component). Preliminary results support using a material-specific processing model to understand the Theory of Mind deficits in right temporal lobe epilepsy amygdalohippocampectomy. Malleability of verbal processing in presence of deterioration of non-verbal processing might have clinical relevance for post-surgery recovery in right temporal lobe epilepsy amygdalohippocampectomy. Documenting the material-specific nature of deficits (verbal versus non-verbal) in non-western, linguistically, and socioeconomically diverse country enables us to understand the problem of heterogeneity in post-surgery cognitive consequences in the right amygdalohippocampectomy.
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Affiliation(s)
- Varsha Singh
- Psychology, Department of Humanities and Social Sciences, Indian Institute of Technology Delhi (IIT), New Delhi, 110016, India
| | - Kirat S Grewal
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, Delhi (AIIMS), Delhi, New Delhi 110029, India
| | - Deepti Vibha
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, Delhi (AIIMS), Delhi, New Delhi 110029, India
| | - Rajesh K Singh
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, Delhi (AIIMS), Delhi, New Delhi 110029, India
| | - Bhargavi Ramanujam
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, Delhi (AIIMS), Delhi, New Delhi 110029, India
| | - Ashima Nehra
- Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), Delhi, New Delhi 110029, India
| | - Sarat P Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), Delhi, New Delhi 110029, India
| | - Shailesh Gaikwad
- Department of Neuroimaging Interventional Neuroradiology, All India Institute of Medical Sciences (AIIMS), Delhi, New Delhi 110029, India
| | - Indupriya Babu
- The UQIDAR Joint Ph.D. program, Indian Institute of Technology Delhi (IIT), New Delhi 110016.India
| | - Manjari Tripathi
- Correspondence to: Manjari Tripathi Room no 705, 7th Floor Department of Neurology AIIMS, New Delhi, Delhi, 110029, India E-mail:
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Vibha D, Kushwaha S, Nath M, Ramanujam B, Elavarasi A, Das A, Radhakrishnan DM, Singh RK, Pandit AK, Srivastava AK, Tripathi M, Anthony A, Maheshwari S. A large cohort study of TB of the central nervous system: clinical outcomes. Int J Tuberc Lung Dis 2022; 26:989-991. [PMID: 36163655 DOI: 10.5588/ijtld.22.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- D Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, Department of Neurology, Institute of Human Behavior and Allied Sciences, Delhi, India
| | | | - M Nath
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, Department of Neurology, Institute of Human Behavior and Allied Sciences, Delhi, India
| | - B Ramanujam
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, Department of Neurology, Institute of Human Behavior and Allied Sciences, Delhi, India
| | - A Elavarasi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, Department of Neurology, Institute of Human Behavior and Allied Sciences, Delhi, India
| | - A Das
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, Department of Neurology, Institute of Human Behavior and Allied Sciences, Delhi, India
| | - D M Radhakrishnan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, Department of Neurology, Institute of Human Behavior and Allied Sciences, Delhi, India
| | - R K Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, Department of Neurology, Institute of Human Behavior and Allied Sciences, Delhi, India
| | - A K Pandit
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, Department of Neurology, Institute of Human Behavior and Allied Sciences, Delhi, India
| | - A K Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, Department of Neurology, Institute of Human Behavior and Allied Sciences, Delhi, India
| | - M Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, Department of Neurology, Institute of Human Behavior and Allied Sciences, Delhi, India
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Girishan S, Chaudhary K, Samala R, Agarwal M, Kumaran S, Doddamani R, Wadhawan AN, Ramanujam B, Chandra SP, Tripathi M. Long-Term Functional Outcome Following Left Hemispherotomy in Adults and Pediatric Participants with Fmri Analysis. Neurol India 2022; 70:1593-1600. [PMID: 36076664 DOI: 10.4103/0028-3886.355100] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background and Objective Hemispherotomy surgery in adults is shrouded in doubts regarding the functional outcome. The age at surgery alone should not be the deciding factor for surgery. Language paradigms were used in functional magnetic resonance imaging (fMRI) to confirm the role played by the age at the onset of seizures to predict the postoperative functional outcome. The objective of the study was to formulate an optimal strategy for patient selection for the left-sided hemispherotomy in adults, based on functional outcome analysis. Materials and Methods A retrospective analysis of 20 participants (age at surgery 1-26 years) who underwent left hemispherotomy (over a 5-year period) was conducted. The language and motor functional assessments of 18 participants (13 pediatric and five adult participants; attrition of participants- two) were recorded at presentation and during follow-up visits. After approval was obtained from the Institutional Ethics Committee, 13 cooperative participants (eight pediatric and five adult participants) underwent language fMRI. Motor fMRI with both active and passive paradigms was done in 16 participants. Results All 18 participants with a mean follow-up of 24 months had class I seizure-free outcome. Of these 18, five were adults (mean age = 21 years, range: 18-22 years) and 13 were in the pediatric age group (mean age = 8 years, range: 2-15 years). Postoperatively, four adults retained both verbal fluency and language comprehension at a mean follow-up period of 38 months (range: 24-48 months). Their pre- and post-op language fMRI showed word generation and regional activations for semantic comprehension in the right hemisphere. The motor area activations were seen in the right hemisphere in two and in the left hemisphere in two participants. Among the pediatric participants, four (group I [n = 4/13]) who had good language outcome showed activations in the right hemisphere. In two participants (group II [n = 2/13]) who deteriorated postoperatively, the activations were in the left hemisphere. Five participants (group III [n = 5/13]) who retained the telegraphic language postoperatively had bilateral activations of semantic comprehension areas in fMRI. All 13 pediatric participants had motor area activations seen in the left hemisphere, similar to controls. Conclusion Left hemispherotomy can be advised to adults with comparably good postoperative language and motor outcome as in the pediatric age group, provided the weakness is acquired perinatally or below the age of 7 years. The fMRI is a valuable tool to aid in patient selection.
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Affiliation(s)
- Shabari Girishan
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kapil Chaudhary
- Department of Nuclear Magnetic Resonance Imaging, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Raghu Samala
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mohit Agarwal
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Senthil Kumaran
- Department of Nuclear Magnetic Resonance Imaging, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ramesh Doddamani
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashima Nehra Wadhawan
- Department of Neuropsychology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Bhargavi Ramanujam
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sarat P Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Doddamani RS, Subianto H, Bajaj J, Girishan S, Samala R, Agrawal M, Ramanujam B, Tripathi M, Chandra PS. Mini Temporal Craniotomy Using Anatomical Surface Landmarks for Temporal Lobe Epilepsy: Technical Note and Clinical Outcomes. Neurol India 2022; 70:524-529. [PMID: 35532614 DOI: 10.4103/0028-3886.344675] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Patients with temporal lobe epilepsy are subjected to standard temporal lobectomy wherever indicated. This is performed using a reverse question mark flap and a standard frontotemporal craniotomy. We describe the technique of minitemporal craniotomy (3 × 3cms) for temporal lobe epilepsy (TLE) and analyze the clinical outcomes of patients operated using this approach. OBJECTIVES To describe the technique of minitemporal craniotomy for TLE without navigation guidance and to analyze the clinical outcomes of patients operated using this approach. MATERIALS AND METHOD This was a retrospective analysis of all consecutive TLE cases operated at our institute from 2014 to 2019, via minitemporal craniotomy, using surface landmarks only without navigation guidance. The surgical technique, indications for surgery, and their clinical outcomes were analyzed. RESULTS A total number of 48 patients underwent surgery for TLE. There were no complications except three patients who had transient hemiparesis. The average duration of hospital stay was 4 days following surgery. Out of 28 patients with mesial temporal sclerosis, 22 (82%) had international league against epilepsy, Class I seizure outcome, 4 (12.5%) had Class II outcome and 2 (5.5%) had Class III outcome. 9 patients with dysembryoplastic neurectodermal tumor (DNET), 4 gangliogliomas, 2 neurocystecercosis (NCC), all had Class I outcome. Out of the five patients with MTS and associated anterior temporal focal cortical dysplasia (FCD), four (80%) had a Class I outcome, whereas one (20%) had Class II outcome. CONCLUSION Utilizing surface anatomical landmarks, minitemporal craniotomy can be performed in even peripheral centers without neuronavigation, with good cosmesis, seizure outcomes.
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Affiliation(s)
| | - Heri Subianto
- Department of Neurosurgery, Airlangga University/Dr Soetomo General Hospital, Surabaya, Indonesia
| | - Jitin Bajaj
- Department of Neurosurgery, Netaji Subhash Chandra Bose Superspecialty Hospital, Jabalpur, India
| | - Shabari Girishan
- Department of Neurosurgery, M S Ramaiah Hospital, Bengaluru, India
| | - Raghu Samala
- Department of Neurosurgery, All India Institute of Medical Sciences, Jabalpur, India
| | - Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Jabalpur, India
| | - Bhargavi Ramanujam
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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8
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Vibha D, Pillai K, Gupta P, Sudheer P, Mishra B, Oinam R, Mohan A, Tayade K, Srivastava P, Tripathi M, Srivastava A, Bhatia R, Rajan R, Pandit A, Singh R, Elavarasi A, Agarwal A, Gupta A, Das A, Radhakrishnan D, Ramanujam B, Soni K, Aggarwal R, Wig N, Trikha A. Comparison of disease profiles and three-month outcomes of patients with neurological disorders with and without COVID-19: An ambispective cohort study. Ann Indian Acad Neurol 2022; 25:218-223. [PMID: 35693663 PMCID: PMC9175394 DOI: 10.4103/aian.aian_602_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/04/2022] Open
Abstract
Objective: Methods: Results: Conclusion:
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9
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Tripathi M, Kaur K, Ramanujam B, Viswanathan V, Bharti K, Singh G, Singh V, Garg A, Bal CS, Tripathi M, Sharma MC, Pandey R, Dash D, Mandal P, Chandra PS. Diagnostic added value of interictal magnetic source imaging in presurgical evaluation of persons with epilepsy: A prospective blinded study. Eur J Neurol 2021; 28:2940-2951. [PMID: 34124810 DOI: 10.1111/ene.14935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/27/2021] [Accepted: 05/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE In presurgical evaluation for epilepsy surgery, information is sourced from various imaging modalities to accurately localize the epileptogenic zone. Magnetoencephalography (MEG) is a newer noninvasive technique for localization. However, there is limited literature to evaluate if MEG provides additional advantage over the conventional imaging modalities in clinical decision making. The objective of this study was to assess the diagnostic added value of MEG in decision making before epilepsy surgery. METHOD This was a prospective observational study. Patients underwent 3 h of recording in a MEG scanner, and the resulting localizations were compared with other complimentary investigations. Added value of MEG (considered separately from high-density electroencephalography) was defined as the frequency of cases in which (i) the information provided by magnetic source imaging (MSI) avoided implantation of intracranial electrodes and the patient was directly cleared for surgery, and (ii) MSI indicated additional substrates for implantation of intracranial electrodes. Postoperative seizure freedom was used as the diagnostic reference by which to measure the localizing accuracy of MSI. RESULTS A total of 102 patients underwent epilepsy surgery. MEG provided nonredundant information, which contributed to deciding the course of surgery in 33% of the patients, and prevented intracranial recordings in 19%. A total of 76% of the patients underwent surgical resection in sublobes concordant with MSI localization, and the diagnostic odds ratio for good (Engel I) outcome in these patients was 2.3 (95% confidence interval 0.68, 7.86; p = 0.183) after long-term follow-up of 36 months. CONCLUSION Magnetic source imaging yields additional useful information which can significantly alter as well as improve the surgical strategy for persons with epilepsy.
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Affiliation(s)
- Manjari Tripathi
- Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kirandeep Kaur
- Neurology, All India Institute of Medical Sciences, New Delhi, India.,MEG Facility, National Brain Research Institute, Manesar, India
| | | | - Vibhin Viswanathan
- Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.,MEG Resource Facility, Collaborative Project Between AIIMS & NBRC, National Brain Research Center, Manesar, India
| | - Kamal Bharti
- MEG Resource Facility, Collaborative Project Between AIIMS & NBRC, National Brain Research Center, Manesar, India
| | - Gaurav Singh
- MEG Resource Facility, Collaborative Project Between AIIMS & NBRC, National Brain Research Center, Manesar, India
| | - Vivek Singh
- MEG Resource Facility, Collaborative Project Between AIIMS & NBRC, National Brain Research Center, Manesar, India
| | - Ajay Garg
- Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Chandra Sekhar Bal
- Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ravindra Pandey
- Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepa Dash
- Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pravat Mandal
- MEG Resource Facility, Collaborative Project Between AIIMS & NBRC, National Brain Research Center, Manesar, India
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10
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Gomathy S, Elavarasi A, Komakula S, Modi M, Sharma MC, Kaur K, Garg A, Tripathi M, Kanodia A, Verma H, Vibha D, Singh RK, Ramanujam B, Tripathi M. A case of multiple cranial nerve palsies. Pract Neurol 2021. [DOI: 10.1136/practneurol-2021-003069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Multiple cranial nerve palsies have many possible causes, including infective, inflammatory, neoplastic and infiltrative diseases of the meninges or skull base. We present the clinicopathological conference of a 27-year-old man with a smouldering course of sequential cranial nerve palsies. His imaging showed dural thickening and osteosclerosis of the skull base with otomastoiditis. Cerebrospinal fluid showed lymphocytic pleocytosis with reduced glucose and normal protein concentrations. There was a possible response to corticosteroids and anti-tubercular treatment. Initial biopsy from the thickened and enhancing dura was unremarkable. His condition deteriorated after the steroids were tapered; MR imaging showed progression of lesions and positron emission tomography showed intense hypermetabolism. Subsequently, a diagnostic test revealed the final diagnosis. This case was presented at the All India Institute of Medical Sciences’ monthly clinicopathological conference series in February 2021.
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11
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Doddamani RS, Samala R, Subianto H, Ramanujam B, Tripathi M, Chandra PS. Robotic-Guided Stereoelectroencephalography for Refractory Epilepsy: Technique and Nuances. Neurol India 2021; 69:587-591. [PMID: 34169847 DOI: 10.4103/0028-3886.319246] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Stereoelectroencephalography (SEEG) has become an integral part of epilepsy surgery, often used in the localization of the epileptogenic zone. It is an essential modality not only in the evaluation of nonlesional but also lesional drug refractory epilepsy, especially in the presence of anatomo-electro-clinical discordance. Objective To describe our technique and the operative nuances involved in the performance of robotic SEEG placement. Methods A 28-year lady with seizure onset at the age of 15 years presented with two types of seizures: one was associated with an aura of chest discomfort, palpitations along with oral and bilateral automatisms. There was associated speech and behavioral arrest along with ictal urinary incontinence. The other type has head turning to the right with secondary generalization lasting up to 1 min. Results Multimodality investigations showed bilateral temporal origin of seizures. SEEG evaluation revealed left amygdala and anterior temporal neocortical (ATL) origin of seizures. The patient underwent left ATL and amygdalectomy. Histopathology revealed focal cortical dysplasia (FCD type Ib). The patient became seizure free (ILAE Class 1) at 1-year follow up. Conclusion Robotic-guided SEEG is a safe and accurate method of evaluating complex MRI negative epilepsy.
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Affiliation(s)
- Ramesh S Doddamani
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Raghu Samala
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Heri Subianto
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhargavi Ramanujam
- Department of Neurosurgery, Airlangga University/Dr Soetomo General Hospital, Surabaya, Indonesia
| | - Manjari Tripathi
- Department of Neurosurgery, Airlangga University/Dr Soetomo General Hospital, Surabaya, Indonesia
| | - Poodipedi S Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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12
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Doddamani RS, Agrawal M, Samala R, Ramanujam B, Chandra PS, Tripathi M. Vagal Nerve Stimulation in the Management of Epilepsy - Recent Concepts. Neurol India 2021; 68:S259-S267. [PMID: 33318360 DOI: 10.4103/0028-3886.302475] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Epilepsy surgery currently offers the best treatment for patients with drug-refractory epilepsy (DRE). Resective surgery, in the presence of a well-localized epileptogenic focus, remains the best modality towards achieving seizure freedom. However, localization of the focus may not be possible in all the cases of DRE, despite comprehensive epilepsy workup. Neuromodulation techniques such as vagal nerve stimulation (VNS), deep brain stimulation (DBS) and responsive neurostimulation (RNS) may be a good alternative in these cases. This article intends to provide an overview of VNS in the management of DRE, including indications, comprehensive preoperative workup, exemplified by case illustrations and outcomes by reviewing the evidence available in the literature.
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Affiliation(s)
| | - Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Raghu Samala
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Bhargavi Ramanujam
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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13
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Tripathi M, Sreedharan Thankarajan AR, Tripathi M, Garg A, Ramanujam B, Snigdha, Bal C. F-18 Fluorodeoxyglucose Positron Emission Tomography Metabolic Phenotype in Myelin Oligodendrocyte Glycoprotein Antibody-Positive Autoimmune Epilepsy. Indian J Nucl Med 2021; 36:88-89. [PMID: 34040310 PMCID: PMC8130699 DOI: 10.4103/ijnm.ijnm_167_20] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/20/2020] [Accepted: 09/11/2020] [Indexed: 11/10/2022] Open
Abstract
We describe the metabolic phenotype on F-18 fluorodeoxyglucose positron emission tomography (PET) in a 13-year-old female with myelin oligodendrocyte glycoprotein (MOG) antibody–positive encephalitis. Unilateral hemispheric hypometabolism on PET may be the metabolic phenotype of autoimmune epilepsy associated with MOG antibody.
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Affiliation(s)
- Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Manjari Tripathi
- Department of Neurology, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Bhargavi Ramanujam
- Department of Neurology, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Snigdha
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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14
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Doddamani RS, Tripathi M, Samala R, Agrawal M, Ramanujam B, Bajaj J, Girishan S, Tripathi M, Bal CS, Garg A, Chandra PS. Hypothalamic Hamartoma and Endocrinopathy: A Neurosurgeon's Perspective. Neurol India 2021; 68:S146-S153. [PMID: 32611907 DOI: 10.4103/0028-3886.287681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The management of hypothalamic hamartomas (HH) rests upon the type of presentation. These are rare congenital benign lesions presenting either with central precocious puberty (CPP), drug refractory epilepsy (DRE) or combination of both. We present here our experience in the management of these lesions from a neurosurgeon's perspective and review the pertinent literature. Objective To present a series of HH presenting with CPP and DRE managed in the neurosurgery department at our center with an emphasis on the associated endocrine abnormalities. Materials and Methods A prospective observational study over a period of five years included 16 patients of HH. All patients were evaluated with 3 Tesla Magnetic Resonance Imaging (MRI) brain, complete hormonal workup including gonadotrophins, testosterone (males) and estradiol (females), and video-electroencephalography (VEEG) as a part of epilepsy workup. All these patients were evaluated with postoperative hormonal workup and repeat MRI brain if repeat surgery was contemplated. Results Among the 16 patients of HH, there were 11 male and 6 female children. All the patients presented with DRE with four of these had associated CPP. All the patients underwent robotic-guided radiofrequency ablation (RFA), with 75% seizure freedom following 1st RFA surgery. Three of the four patients with CPP achieved both clinical and biochemical normalization. One patient had just a marginal reduction in the serum gonadotrophins. One patient was reoperated twice and three underwent RFA thrice. Conclusion The management of HH should be individualized with DRE taking the precedence requiring early surgery. A multidisciplinary approach is therefore recommended for a successful outcome.
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Affiliation(s)
- Ramesh S Doddamani
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Raghu Samala
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Bhargavi Ramanujam
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Jitin Bajaj
- Department of Neurosurgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Shabari Girishan
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - C S Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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15
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Chandra PS, Doddamani R, Girishan S, Samala R, Agrawal M, Garg A, Ramanujam B, Tripathi M, Bal C, Nehra A, Tripathi M. Robotic thermocoagulative hemispherotomy: concept, feasibility, outcomes, and safety of a new "bloodless" technique. J Neurosurg Pediatr 2021; 27:688-699. [PMID: 33799306 DOI: 10.3171/2020.10.peds20673] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors present a new "bloodless" technique for minimally invasive robotic thermocoagulative hemispherotomy (ROTCH). Such a method is being described in the literature for the first time. METHODS A robotic system was used to plan five sets of different trajectories: anterior disconnection, middle disconnection, posterior disconnection, corpus callosotomy, and temporal stem and amygdalar disconnection. A special technique, called the "X" technique, allowed planar disconnection. Registration was performed with surface landmarks (n = 5) and bone fiducials (n = 1). Coregistration with O-arm images was performed one or two times to confirm the trajectories (once for middle disconnection, and once for disconnection of the temporal stem and amygdala or body of the corpus callosum). Impedance measured before ablation allowed for minor adjustments. Radiofrequency ablation was performed at 75°C-80°C for 60 seconds. Surgical procedures were performed with multiple twist drills. After removal of the electrode, glue was used to prevent CSF leak, and a single stitch was applied. Follow-up CT and MRI were immediately performed. RESULTS The pathologies included Rasmussen's encephalitis (n = 2), hemispheric cortical dysplasia (n = 2), posttraumatic encephalomalacia (n = 1), and perinatal insult (n = 1). The mean ± SD (range) age was 6.7 ± 3.6 years (5 months to 10.2 years), and the right side was affected in 4 patients. The mean ± SD seizure frequency was 7.4 ± 5.6 seizures per day (1 patient had epilepsia partialis continua). The mean ± SD number of trajectories was 15.3 ± 2.5, and the mean ± SD number of lesions was 108 ± 25.8. The mean ± SD maximum numbers of trajectories and lesions required for middle disconnection were 7.1 ± 1.7 and 57.5 ± 18.4, respectively. All but 1 patient had class 1 outcomes according to the International League Against Epilepsy Outcome Scale at a mean ± SD (range) follow-up of 13.5 ± 1.6 (12-16) months; the remaining patient had a class 2 outcome. The estimated blood loss was < 5 ml for all patients. Complications included repeat surgery (after 2 weeks) for a "skip" area (n = 1) and a small temporal hematoma (n = 1), which resolved. CONCLUSIONS ROTCH seems to be a safe, feasible, and bloodless procedure, with a very low morbidity rate and promising outcomes.
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Affiliation(s)
- P Sarat Chandra
- Departments of1Neurosurgery.,6Center of Excellence for Epilepsy and MEG, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Doddamani
- Departments of1Neurosurgery.,6Center of Excellence for Epilepsy and MEG, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | | | | | | | - Manjari Tripathi
- 4Neurology, and.,6Center of Excellence for Epilepsy and MEG, All India Institute of Medical Sciences, New Delhi, India
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16
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Agarwal M, Arushi A, Dhingra LS, Patel LJ, Agrawal S, Srivastava P, Tripathi M, Srivastava A, Bhatia R, Singh MB, Prasad K, Vibha D, Vishnu VY, Rajan R, Pandit AK, Singh RK, Gupta A, Radhakrishnan DM, Das A, Ramanujam B, Agarwal A, Elavarasi A. Patient Experience of a Neurology Tele-Follow-Up Program Initiated During the Coronavirus Disease 2019 Pandemic: A Questionnaire-Based Study. Telemed Rep 2021; 2:88-96. [PMID: 35720744 PMCID: PMC8989087 DOI: 10.1089/tmr.2020.0034] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 06/15/2023]
Abstract
Background: Teleneurology consultations can be highly advantageous since neurological diseases and disabilities often limit patient's access to health care, particularly in a setting where they need to travel long distances for specialty consults. Patient satisfaction is an important outcome assessing success of a telemedicine program. Materials and Methods: A cross-sectional study was conducted to determine satisfaction and perception of patients toward an audio call based teleneurology follow-up initiated during the coronavirus disease 2019 pandemic. Primary outcomes were satisfaction to tele-consult, and proportion of patients preferring telemedicine for future follow-up. Results: A total of 261 patients who received tele-consult were enrolled. Satisfaction was highest for domain technological quality, followed by patient-physician dialogue (PPD) and least to quality of care (QoC). Median (interquartile range) patient satisfaction on a 5-point Likert scale was 4 (3-5). Eighty-five (32.6%; 95% confidence interval 26.9-38.6%) patients preferred telemedicine for future follow-up. Higher overall satisfaction was associated with health condition being stable/better, change in treatment advised on tele-consult, diagnosis not requiring follow-up examination, higher scores on domains QoC and PPD (p < 0.05). Future preference for telemedicine was associated with patient him-/herself consulting with doctor, less duration of follow-up, higher overall satisfaction, and higher scores on domain QoC (p < 0.05). On thematic analysis, telemedicine was found convenient, reduced expenditure, and had better physician attention; in-person visits were comprehensive, had better patient-physician relationship, and better communication. Discussion: Patient satisfaction was lower in our study than what has been observed earlier, which may be explained by the primitive nature of our platform. Several variables related to the patients' disease process have an effect on patient satisfaction. Conclusion: Development of robust, structured platforms is necessary to fully utilize the potential of telemedicine in developing countries.
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Affiliation(s)
- Mudit Agarwal
- MBBS, All India Institute of Medical Sciences, New Delhi, India
| | - Arushi Arushi
- MBBS, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Achal Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Awadh Kishor Pandit
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumar Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Animesh Das
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhargavi Ramanujam
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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17
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Kaur K, Garg A, Tripathi M, Chandra SP, Singh G, Viswanathan V, Bharti K, Singh V, Ramanujam B, Bal CS, Sharma MC, Pandey R, Vibha D, Singh RK, Mandal PK, Tripathi M. Comparative contribution of magnetoencephalography (MEG) and single-photon emission computed tomography (SPECT) in pre-operative localization for epilepsy surgery: A prospective blinded study. Seizure 2021; 86:181-188. [PMID: 33647809 DOI: 10.1016/j.seizure.2021.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 01/20/2023] Open
Abstract
PURPOSE The aim of this study was to compare the diagnostic value and accuracy of ictal SPECT and inter-ictal magnetoencephalography (MEG) in localizing the site for surgery in persons with drug resistant epilepsy. METHOD This was a prospective observational study. Patients expected to undergo epilepsy surgery were enrolled consecutively and the localization results from different imaging modalities were discussed in an epilepsy surgery meet. Odds ratio of good outcome (Engel I) were calculated in patients who underwent surgery in concordance with MEG and SPECT findings. Post-surgical seizure freedom lasting at least 36 months or more was considered the gold standard for determining the diagnostic output of SPECT and MEG. RESULTS MEG and SPECT were performed in 101 and 57 patients respectively. In 45 patients SPECT could not be done due to delay in injection or technical factors. The accuracy of MEG and SPECT in localizing the epileptogenic zone was found to be 74.26 % and 78.57 % respectively. The diagnostic odds ratio for Engel I surgical outcome was reported as 2.43 and 5.0 for MEG and SPECT respectively. The diagnostic odds ratio for MEG in whom SPECT was non-informative was found to be 6.57 [95 % CI 1.1, 39.24], although it was not significantly associated with good surgical outcome. MEG was useful in indicating sites for SEEG implantation. CONCLUSION SPECT was found to be non-informative for most patients, but reported better diagnostic output than MEG. MEG may be a useful alternative for patients in whom SPECT cannot be done or was non-localizing.
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Affiliation(s)
- Kirandeep Kaur
- Dept of Neurology, All India Institute of Medical Sciences, New Delhi, India; MEG Facility, National Brain Research Institute, Manesar, India
| | - Ajay Garg
- Dept of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Dept of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sarat P Chandra
- Dept of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Singh
- MEG Facility, National Brain Research Institute, Manesar, India
| | | | - Kamal Bharti
- MEG Facility, National Brain Research Institute, Manesar, India
| | - Vivek Singh
- MEG Facility, National Brain Research Institute, Manesar, India
| | - Bhargavi Ramanujam
- Dept of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Chandra Sekhar Bal
- Dept of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar Chand Sharma
- Dept of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra Pandey
- Dept of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Dept of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumar Singh
- Dept of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Manjari Tripathi
- Dept of Neurology, All India Institute of Medical Sciences, New Delhi, India.
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18
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Gupta A, Vishnu VY, Singh MB, Bhatia R, Rajan R, Vibha D, Elavarasi A, Radhakrishnan D, Agarwal A, Ramanujam B, Das A, Singh RK, Pandit AK, Srivastava A, Tripathi M, Prasad K, Srivastava MVP. Managing Non-COVID Acute Neurology Amidst the Pandemic: Challenges and Work in Progress. Ann Indian Acad Neurol 2021; 24:11-14. [PMID: 33911373 PMCID: PMC8061500 DOI: 10.4103/aian.aian_999_20] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/29/2020] [Accepted: 01/06/2021] [Indexed: 11/04/2022] Open
Abstract
The ongoing COVID-19 pandemic has precipitated a global health crisis. Non-COVID diseases across specialties have been significantly compromised. The greatest challenge has been to continue providing care to non-COVID cases with minimum transmission risk to health care workers, patients, and caregivers. In this specter, better described as a medical holocaust, we present our experiences of dealing with acute neurological patients who could access our facility. We attempted to work on three key areas - initial screening using a more inclusive, dynamic checklist for COVID suspicion over and above the emergency triage, a mandatory initial holding on a separate floor of our inpatient service equipped with infection control strategies similar to a COVID-designated area, and daily screening of health care workers and caregivers for symptoms and possible exposures. It was a steep learning curve, a couple of close shaves, and many more lessons that went into the development of an algorithm that seems to be working well.
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Affiliation(s)
- Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta B Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Divya Radhakrishnan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhargavi Ramanujam
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Animesh Das
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh K Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Awadh K Pandit
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Achal Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.,Department of Rajendra Institute of Medical Sciences, Ranchi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Kaur K, Agrawal M, Yadav M, Chandra PS, Samala R, Doddamani R, Ramanujam B, Singh G, Tripathi M. On-scalp magnetoencephalography: A long but promising road ahead? Clin Neurophysiol 2021; 132:696-697. [PMID: 33451961 DOI: 10.1016/j.clinph.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Kirandeep Kaur
- Dept. of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India; MEG Facility, National Brain Research Centre, Manesar, Haryana, India
| | - Mohit Agrawal
- Dept. of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Meenu Yadav
- MEG Facility, National Brain Research Centre, Manesar, Haryana, India
| | - P Sarat Chandra
- Dept. of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Raghu Samala
- Dept. of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ramesh Doddamani
- Dept. of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Bhargavi Ramanujam
- Dept. of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Gaurav Singh
- MEG Facility, National Brain Research Centre, Manesar, Haryana, India
| | - Manjari Tripathi
- Dept. of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Tripathi M, Thankarajan ARS, Ihtisham K, Garg A, Vibha D, Singh R, Ramanujam B, Varsi E, Bal C, Tripathi M. Metabolic scoring in autoimmune epilepsy-Should APE scores be modified? Acta Neurol Scand 2021; 143:13-18. [PMID: 32939762 DOI: 10.1111/ane.13346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We evaluate the potential utility of F-18 FDG-PET in addition to MRI in the diagnostic work-up of patients with autoimmune epilepsy (AE) and propose the inclusion of functional imaging in the antibody prevalence in epilepsy (APE) scoring system. METHODS This was a retrospective analysis in 60 patients, diagnosed and treated for AE, of whom 40 were antibody negative (presumed AE) and 20 were antibody positive (definitive AE). All patients had undergone a dedicated brain and whole body FDG-PET in the department of Nuclear Medicine. RESULTS In the antibody negative group, MRI supported a diagnosis of AE in 23 patients. Both MRI and PET were indicative in 12 cases, and standalone PET was positive in 8. While MRI alone was diagnostic in 57% (23/40), the combined yield of both modalities was 77% (31/40). When PET scores were added to assign the APE score in MRI negative cases, average APE score was 5.4. In the antibody positive group, MRI supported the diagnosis of AE in 7 patients. Both MRI and PET were positive in 4 patients and standalone PET was positive in 5 patients. While MRI alone was diagnostic in 35% (7/20), the combined yield of both modalities was 60% (12/20). When PET scores were added to assign the APE score in MRI negative cases, average APE score was 6.1. CONCLUSION The inclusion of metabolic information from PET distinctly improved (the sensitivity of) APE scores to predict autoimmune origin even in antibody negative cases. A larger prospective study of similar type could justify adoption of FDG-PET into the standard diagnostic procedure.
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Affiliation(s)
- Madhavi Tripathi
- Department of Nuclear Medicine All India Institute of Medical Sciences New Delhi India
| | | | - Kavish Ihtisham
- Department of Neurology Neurosciences Centre All India Institute of Medical Sciences New Delhi India
| | - Ajay Garg
- Department of Neuroimaging & Interventional Neuroradiology Neurosciences Centre All India Institute of Medical Sciences New Delhi India
| | - Deepti Vibha
- Department of Neurology Neurosciences Centre All India Institute of Medical Sciences New Delhi India
| | - Rajesh Singh
- Department of Neurology Neurosciences Centre All India Institute of Medical Sciences New Delhi India
| | - Bhargavi Ramanujam
- Department of Neurology Neurosciences Centre All India Institute of Medical Sciences New Delhi India
| | - Ela Varsi
- Department of Neurology Neurosciences Centre All India Institute of Medical Sciences New Delhi India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine All India Institute of Medical Sciences New Delhi India
| | - Manjari Tripathi
- Department of Neurology Neurosciences Centre All India Institute of Medical Sciences New Delhi India
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Bhatia R, Gupta P, Misra B, Sudheer P, Singh M, P. Srivastava MV, Tripathi M, Srivastava A, Prasad K, Vibha D, Vishnu VY, Rajan R, Pandit A, Singh R, Gupta A, Elavarasi A, Das A, Divya MR, Ramanujam B, Agarwal A. Patients with neurological illnesses and their experience during the lockdown: A teleinterview-based study. Ann Indian Acad Neurol 2021; 25:76-81. [PMID: 35342269 PMCID: PMC8954335 DOI: 10.4103/aian.aian_468_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Materials and Methods: Results: Conclusion:
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Kaur K, Chandra PS, Samala R, Agrawal M, Doddamani R, Ramanujam B, Singh G, Tripathi M. Bridging the gap between analytical methods and their clinical interpretation. Epilepsia 2020; 61:2609-2610. [PMID: 33063844 DOI: 10.1111/epi.16706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Kirandeep Kaur
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.,MEG Facility, National Brain Research Centre, Manesar, India
| | - Poodepedi Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Raghu Samala
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ramesh Doddamani
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Bhargavi Ramanujam
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Gaurav Singh
- MEG Facility, National Brain Research Centre, Manesar, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Vibha D, Srivastava MVP, Prasad K, Tripathi M, Srivastava AK, Bhatia R, Singh MB, VY V, Rajan R, Pandit AK, Singh RK, Das A, Gupta A, Elavarasi A, MR D, Ramanujam B, Shariff A. Connecting in COVID 19: Neurology telephonic-follow-up experience in the pandemic (Preprint). JMIR Form Res 2020. [DOI: 10.2196/24262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bajaj J, Chaudhary K, Chandra PS, Ramanujam B, Girishan S, Doddamani R, Tripathi M, Nehra A, Tripathi M. Left Temporal Lobectomy Using Functional MRI in a Math Genius: A Case Report. Neurol India 2020; 68:170-172. [PMID: 32129271 DOI: 10.4103/0028-3886.279704] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Standard treatment of drug-refractory epilepsy, due to left mesial temporal sclerosis, is anterior temporal lobectomy with amygdalohippocampectomy (ATL). This carries a risk of cognitive deficits, including comprehension, verbal memory, and visual memory. Preoperative language lateralization and localization is important to preserve these functions. Often Wada testing is used for these, but it carries risk due to its invasive nature. In addition, it can lateralize but not localize and may not be readily available. We hereby present a mathematics genius who underwent left ATL under the guidance of functional MRI and neuropsychological assessment alone, resulting in the preservation of all of his cognitive abilities even in the immediate postoperative period. A video demonstration of his calendar likeability is also shown.
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Affiliation(s)
- Jitin Bajaj
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Chaudhary
- Department of Biomedical Engineering/NMR, IIT/AIIMS, New Delhi, India
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Bhargavi Ramanujam
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Shabari Girishan
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Doddamani
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashima Nehra
- Department of Neuropsychology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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25
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Kumar S, Sarangi SC, Tripathi M, Ramanujam B, Gupta YK. Seizure recurrence risk in persons with epilepsy undergoing antiepileptic drug tapering. Acta Neurol Scand 2020; 141:65-76. [PMID: 31618439 DOI: 10.1111/ane.13183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Antiepileptic drug (AED) tapering in persons with epilepsy (PWE) after 2-3 years of seizure freedom is still debatable because of the risk of seizure recurrence. Tapering patterns have wide variability and could impact seizure recurrence; this study aimed to find out the correlation between them. MATERIAL AND METHODS This prospective, observational independent assessor study enrolled PWE undergoing AED tapering in a tertiary care hospital. Data collected included demography, seizure history, AED treatment, and investigational findings. Tapering pattern was assessed based on seizure-free period and AED dose before onset of tapering, dose reduction percentage and frequency, duration of tapering, and follow-up. These variables were compared among the PWE with seizure recurrence and no seizure recurrence. RESULTS Among 408 enrolled PWE, 181 were on AED monotherapy: levetiracetam (73), valproate (45), carbamazepine (44), phenytoin (16), and clobazam (3). With a minimum 19 (maximum 41 months) follow-up, seizure recurrence was reported in 119 (29.2%) PWE. The seizure recurrence was not significantly different in-between mono and polytherapy groups; however, among monotherapy groups seizure recurrence was significantly higher (P = .023) in valproate (35.5%) followed by levetiracetam (28.8%) group. Parameters having significant association with seizure recurrence were duration of epilepsy (P = .03), frequency of seizures before control (P = .002), history of previously failed tapering (P = .04), and history of smoking/alcoholic/tobacco intake (P = .003). CONCLUSIONS There is a wide variation in AEDs tapering pattern and seizure recurrence risk can be minimized by considering the risk factors like history of smoking/alcoholic/tobacco, longer duration of epilepsy, frequency of seizures before control, and previously failed tapering.
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Affiliation(s)
- Sachin Kumar
- Department of Pharmacology All India Institute of Medical Sciences New Delhi India
| | | | - Manjari Tripathi
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Bhargavi Ramanujam
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Yogendra Kumar Gupta
- Department of Pharmacology All India Institute of Medical Sciences New Delhi India
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Chandra P, Samala R, Agrawal M, Doddamani R, Ramanujam B, Tripathi M. Vagal Nerve Stimulation for Drug Refractory Epilepsy. Neurol India 2020; 68:S325-S327. [DOI: 10.4103/0028-3886.302458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Girishan S, Tripathi M, Garg A, Doddamani R, Bajaj J, Ramanujam B, Chandra PS. Enhancing outcomes of endoscopic vertical approach hemispherotomy: understanding the role of "temporal stem" residual connections causing recurrence of seizures. J Neurosurg Pediatr 2019; 25:1-9. [PMID: 31703206 DOI: 10.3171/2019.8.peds19148] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 08/19/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to analyze the residual connections formed by the temporal stem as a cause for seizure recurrence following endoscopic vertical interhemispheric hemispherotomy and to review and compare lateral approach (perisylvian) with vertical approach surgical techniques to highlight the anatomical factors responsible for residual connections. METHODS This study was a retrospective analysis of patients who underwent endoscopic hemispherotomy for drug-resistant epilepsy. Postoperative MR images were analyzed. Specific attention was given to anatomical 3D-acquired thin-section T1 images to assess the extent of disconnection, which was confirmed with a diffusion tensor imaging sequence. Cadaver brain dissection was done to analyze the anatomical factors responsible for persistent connections. RESULTS Of 39 patients who underwent surgery, 80% (31/39) were seizure free (follow-up of 23.61 ± 8.25 months) following the first surgery. Thirty patients underwent postoperative MRI studies, which revealed persistent connections in 14 patients (11 temporal stem only; 3 temporal stem + amygdala + splenium). Eight of these 14 patients had persistent seizures. In 4 of these 8 patients, investigations revealed good concordance with the affected hemisphere, and repeat endoscopic disconnection of the residual connection was performed. Two of the 8 patients were lost to follow-up, and 2 had bihemispheric seizure onset. The 4 patients who underwent repeat endoscopic disconnection had seizure-free outcomes following the second surgery, increasing the good outcome total among all patients to 90% (35/39). Cadaveric brain dissection analysis revealed the anatomical factors responsible for the persistence of residual connections. CONCLUSIONS In endoscopic vertical approach interhemispheric hemispherotomy (and also vertical approach parasagittal hemispherotomy) the temporal stem, which lies deep and parallel to the plane of disconnection, is prone to be missed, which might lead to persistent or recurrent seizures. The recognition of this limitation can lead to improved seizure outcome. The amygdala and splenium are areas less commonly prone to be missed during surgery.
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Affiliation(s)
| | | | - Ajay Garg
- 3Neuroradiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Bajaj J, Chandra SP, Ramanujam B, Girishan S, Doddamani R, Tripathi M. Need of Immediate Drug Reduction after Epilepsy Surgery - A Prospective Observational Study. Neurol India 2019; 67:1050-1053. [PMID: 31512632 DOI: 10.4103/0028-3886.266282] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Patients undergoing epilepsy surgery are on polytherapy. Drug tapering is usually done after 1 year in adults and after 6 months in children. Sometimes, drugs have to be altered during the perioperative period, which is more commonly seen in hemispherotomy (HS) patients. The present study was done to compare perioperative drug alterations between HS and temporal (TL) lobectomy patients. Materials and Methods Prospective analysis of postoperative HS and TL patients was done. Primary outcomes were drug number, dosage changes, and seizure outcome. Secondary outcome studied was a change in intelligence quotient (IQ) in the two groups. Results At total of 71 patients were included. Perioperative drug stopping (clobazam - CLB) was needed in 3/38 patients in the HS group, due to sedation. Dosage was reduced in 23/38 (60.52%) in HS group, and in 2/33 (6%) in TL group P < 0.001. The most common drug was CLB, with reduction in 21/27 (77.77%) patients, with a mean reduction of 41.21 ± 4.01%. Two patients required drug substitution in the HS group. About 64/71 (90.1%) patients achieved Class I outcome at a 1-year postoperative time point (TL - 90.9%, HS - 89.47%). There was no change in IQ in any of the groups. Conclusion Perioperative drug alteration is often needed in the HS patients as compared to TL patients. Benzodiazepines have to be reduced to maintain alertness in the HS patients. The increased sedation postoperatively can be due to decreased cortical drive over the reticular activating system, gamma-aminobutyric acid (GABA) receptor denervation hypersensitivity, or increased activity of drugs over the remaining active hemisphere.
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Affiliation(s)
- Jitin Bajaj
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sarat P Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Bhargavi Ramanujam
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Shabari Girishan
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Doddamani
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Ramanujam B, Bajaj BK, Kaur K, Anand KS, Buxi G. Is Depression Related to Low Folate Levels in People with Epilepsy? An Observational Study and Meta-analysis. J Neurosci Rural Pract 2019; 8:381-388. [PMID: 28694617 PMCID: PMC5488558 DOI: 10.4103/jnrp.jnrp_468_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/19/2022] Open
Abstract
Background: Both depression and low serum levels of folate are common in people with epilepsy (PWE), the latter especially in patients on hepatic enzyme-inducing antiepileptic drugs (AEDs). We did a cross-sectional study and a meta-analysis to assess if lower folate levels have any relation with depression in PWE. Materials and Methods: Two hundred and one PWE were recruited and assessed for depression using the Inventory of Depressive Symptomatology-Self-Rated (IDS-SR) and Inventory of Depressive Symptomatology-Clinician Rated; serum folate levels were measured in them at the same time. Literature search was carried out and studies with data on depression as well as folate levels in PWE were included. Statistical analysis to determine frequency of depression, low folate levels, and relation between them among our cases and the pooled data from the included studies was done. Results: Depression was observed in 65.68% and low serum folate (<4 ng/ml) in 48.75% of PWE (over 80% on older AEDs); there was no statistically significant correlation between them. However, on analyzing the pooled data of six studies including the present, the Fisher's z-transformed correlation coefficient was −0.1690 (95% confidence interval [−0.3175, −0.0124], P = 0.0464). Conclusions: Depression and low folate levels are common in PWE. Low folate levels have a mild but significant negative correlation with depression in this population, and folate supplementation would be advisable for those on the older AEDs.
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Affiliation(s)
- Bhargavi Ramanujam
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India.,Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhupender Kumar Bajaj
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Kirandeep Kaur
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kuljeet Singh Anand
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Gurdeep Buxi
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Ihtisham K, Ramanujam B, Srivastava S, Mehra NK, Kaur G, Khanna N, Jain S, Kumar S, Kaul B, Samudrala R, Tripathi M. Association of cutaneous adverse drug reactions due to antiepileptic drugs with HLA alleles in a North Indian population. Seizure 2019; 66:99-103. [PMID: 30826555 DOI: 10.1016/j.seizure.2019.02.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/14/2019] [Accepted: 02/16/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Aromatic antiepileptic drugs (AEDs) are frequently implicated in cutaneous adverse drug reactions (cADRs), a few of which are associated with certain human leukocyte antigen (HLA) alleles in some populations. We aimed to find HLA-associations with AED-related cADRs among North Indians. METHODS North Indian subjects with cADR due to an AED, and those who were AED-tolerant were recruited as cases and controls, respectively. Genotyping for HLA-A, B and DRB1 were performed. Statistical analysis to compare carrier-rates and allele-frequencies between cases and controls (and healthy population, where necessary), was done for HLA-alleles occurring more than twice in either group. RESULTS 120 cases {11 - Lamotrigine (LTG), 14 -Valproic acid (VPA), 8 -Levetiracetam (LEV), 35 -Carbamazepine (CBZ) and 52 - Phenytoin (PHT)}, and 250 controls were recruited. Presence of HLA-A*31:01 and HLA-B*51:01 were found to increase the risk of Maculopapular exanthema (MPE) due to CBZ and PHT (OR = 6.38; 95% CI: 1.46-27.75; OR = 4.60; 95% CI: 1.54-13.72, respectively). Among the severe cADRs, HLA-B*57:01(OR = 11.00 95% CI: 1.41-85.81) and HLA-DRB1*07:01 (OR = 7.25; 95% CI: 1.09-48.18) were noted to be significantly associated with CBZ-induced Stevens Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN); HLA-B *51:01 was associated with drug reaction eosinophilia and systemic symptoms (DRESS) caused by PHT (OR = 6.90; 95% CI: 1.38-34.29). CONCLUSIONS We found significant associations of some HLA alleles with specific cADRs to CBZ and PHT in North Indians, which may need to be tested before AED-initiation; only screening for HLA-B*15:02 may not help in this population.
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Affiliation(s)
- Kavish Ihtisham
- All India Institute of Medical Sciences, Neurology, Neurosciences Centre, Room no-705, 7th floor, 110029, New Delhi, India
| | - Bhargavi Ramanujam
- All India Institute of Medical Sciences, Neurology, Neurosciences Centre, Room no-705, 7th floor, 110029, New Delhi, India
| | - Shivani Srivastava
- All India Institute of Medical Sciences, Neurology, Neurosciences Centre, Room no-705, 7th floor, 110029, New Delhi, India
| | - Narinder Kumar Mehra
- Dr. C.G. Pandit National Chair and Ex-head, Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
| | - Gurvinder Kaur
- Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Khanna
- Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Satish Jain
- Director Indian Epilepsy Centre and President-elect Indian Epilepsy Association
| | - Sachin Kumar
- Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavna Kaul
- Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Raghavan Samudrala
- Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Manjari Tripathi
- All India Institute of Medical Sciences, Neurology, Neurosciences Centre, Room no-705, 7th floor, 110029, New Delhi, India.
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Chandra PS, Subianto H, Bajaj J, Girishan S, Doddamani R, Ramanujam B, Chouhan MS, Garg A, Tripathi M, Bal CS, Sarkar C, Dwivedi R, Sapra S, Tripathi M. Endoscope-assisted (with robotic guidance and using a hybrid technique) interhemispheric transcallosal hemispherotomy: a comparative study with open hemispherotomy to evaluate efficacy, complications, and outcome. J Neurosurg Pediatr 2018; 23:187-197. [PMID: 30497135 DOI: 10.3171/2018.8.peds18131] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/09/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEEndoscope-assisted hemispherotomy (EH) has emerged as a good alternative option for hemispheric pathologies with drug-resistant epilepsy.METHODSThis was a prospective observational study. Parameters measured included primary outcome measures (frequency, severity of seizures) and secondary outcomes (cognition, behavior, and quality of life). Blood loss, operating time, complications, and hospital stay were also taken into account. A comparison was made between the open hemispherotomy (OH) and endoscopic techniques performed by the senior author.RESULTSOf 59 cases (42 males), 27 underwent OH (8 periinsular, the rest vertical) and 32 received EH. The mean age was 8.65 ± 5.41 years (EH: 8.6 ± 5.3 years; OH: 8.6 ± 5.7 years). Seizure frequency per day was 7 ± 5.9 (EH: 7.3 ± 4.6; OH: 15.0 ± 6.2). Duration of disease (years since first episode) was 3.92 ± 1.24 years (EH: 5.2 ± 4.3; OH: 5.8 ± 4.5 years). Number of antiepileptic drugs per patient was 3.9 ± 1.2 (EH: 4.2 ± 1.2; OH: 3.8 ± 0.98). Values for the foregoing variables are expressed as the mean ± SD. Pathologies included the following: postinfarct encephalomalacia in 19 (EH: 11); Rasmussen's syndrome in 14 (EH: 7); hemimegalencephaly in 12 (EH: 7); hemispheric cortical dysplasia in 7 (EH: 4); postencephalitis sequelae in 6 (EH: 2); and Sturge-Weber syndrome in 1 (EH: 1). The mean follow-up was 40.16 ± 17.3 months. Thirty-nine of 49 (79.6%) had favorable outcomes (International League Against Epilepsy class I and II): in EH the total was 19/23 (82.6%) and in OH it was 20/26 (76.9%). There was no difference in the primary outcome between EH and OH (p = 0.15). Significant improvement was seen in the behavioral/quality of life performance, but not in IQ scores in both EH and OH (p < 0.01, no intergroup difference). Blood loss (p = 0.02) and hospital stay (p = 0.049) were less in EH.CONCLUSIONSEH was as effective as the open procedure in terms of primary and secondary outcomes. It also resulted in less blood loss and a shorter postoperative hospital stay.
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Affiliation(s)
- P Sarat Chandra
- Departments of1Neurosurgery.,3COE, Epilepsy, National Brain Research Centre and All India Institute of Medical Sciences, New Delhi; and
| | - Heri Subianto
- Departments of1Neurosurgery.,3COE, Epilepsy, National Brain Research Centre and All India Institute of Medical Sciences, New Delhi; and
| | - Jitin Bajaj
- Departments of1Neurosurgery.,3COE, Epilepsy, National Brain Research Centre and All India Institute of Medical Sciences, New Delhi; and
| | - Shabari Girishan
- Departments of1Neurosurgery.,3COE, Epilepsy, National Brain Research Centre and All India Institute of Medical Sciences, New Delhi; and
| | | | - Bhargavi Ramanujam
- 2Neurology.,3COE, Epilepsy, National Brain Research Centre and All India Institute of Medical Sciences, New Delhi; and
| | | | | | | | | | | | | | - Savita Sapra
- 8Pediatric Neuropsychology, All India Institute of Medical Sciences, New Delhi
| | - Manjari Tripathi
- 2Neurology.,3COE, Epilepsy, National Brain Research Centre and All India Institute of Medical Sciences, New Delhi; and
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Radhakrishnan DM, Ramanujam B, Srivastava P, Dash D, Tripathi M. Effect of providing sudden unexpected death in epilepsy (SUDEP) information to persons with epilepsy (PWE) and their caregivers-Experience from a tertiary care hospital. Acta Neurol Scand 2018; 138:417-424. [PMID: 29984404 DOI: 10.1111/ane.12994] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 06/19/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The primary objective of present study was to observe the effect of providing SUDEP (Sudden Unexpected Death in Epilepsy) information on drug adherence in persons with epilepsy (PWE). We also looked at impact of disclosing SUDEP information on patient's quality of life and mood. MATERIAL AND METHODS This prospective study had a pretest/post-test design. A total of 231 consecutive PWE (>15 years) were enrolled. Of these 121 PWE received information about SUDEP in addition to standard epilepsy care. One hundred and ten PWE (control group) received routine standard epilepsy care but did not receive SUDEP information. Follow up assessment was done at 6 months. The primary outcome was a change in drug adherence (measured by Modified Morisky Medication Adherence Scale, MMAS) in PWE following disclosure of SUDEP information. RESULTS After 6 months, 116 PWE in the SUDEP information group and 106 in control group were available for follow up. A non-significant higher adherence was observed in the SUDEP information group as compared to the control group (Mean MMAS change 0.51 ± 1.66 vs 0.25 ± 1.26, P value = 0.194). No significant change was perceived in patient's anxiety and depression levels or quality of life in either group. CONCLUSION The present study suggests that providing information on SUDEP to PWE and their caregivers may increase drug adherence without adverse effect on quality of life or mood. Well-designed studies with high methodological quality are required to determine the precise effect size associated with disclosure of SUDEP information on drug adherence in PWE.
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Affiliation(s)
| | - Bhargavi Ramanujam
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - Padma Srivastava
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - Deepa Dash
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - Manjari Tripathi
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
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Paul D, Dixit A, Srivastava A, Tripathi M, Prakash D, Sarkar C, Ramanujam B, Banerjee J, Chandra PS. Altered transforming growth factor beta/SMAD3 signalling in patients with hippocampal sclerosis. Epilepsy Res 2018; 146:144-150. [DOI: 10.1016/j.eplepsyres.2018.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/23/2018] [Accepted: 08/18/2018] [Indexed: 01/10/2023]
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Kumar S, Ramanujam B, Chandra PS, Dash D, Mehta S, Anubha S, Appukutan R, Rana MK, Tripathi M. Randomized controlled study comparing the efficacy of rapid and slow withdrawal of antiepileptic drugs during long-term video-EEG monitoring. Epilepsia 2017; 59:460-467. [DOI: 10.1111/epi.13966] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Shambhu Kumar
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - Bhargavi Ramanujam
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - PS Chandra
- Department of Neurosurgery; All India Institute of Medical Sciences; New Delhi India
| | - Deepa Dash
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - Santosh Mehta
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - Sharma Anubha
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - Renjith Appukutan
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - Manit Kumar Rana
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - Manjari Tripathi
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
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Dwivedi R, Ramanujam B, Chandra PS, Sapra S, Gulati S, Kalaivani M, Garg A, Bal CS, Tripathi M, Dwivedi SN, Sagar R, Sarkar C, Tripathi M. Surgery for Drug-Resistant Epilepsy in Children. N Engl J Med 2017; 377:1639-1647. [PMID: 29069568 DOI: 10.1056/nejmoa1615335] [Citation(s) in RCA: 322] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neurosurgical treatment may improve seizures in children and adolescents with drug-resistant epilepsy, but additional data are needed from randomized trials. METHODS In this single-center trial, we randomly assigned 116 patients who were 18 years of age or younger with drug-resistant epilepsy to undergo brain surgery appropriate to the underlying cause of epilepsy along with appropriate medical therapy (surgery group, 57 patients) or to receive medical therapy alone (medical-therapy group, 59 patients). The patients in the medical-therapy group were assigned to a waiting list for surgery. The primary outcome was freedom from seizures at 12 months. Secondary outcomes were the score on the Hague Seizure Severity scale, the Binet-Kamat intelligence quotient, the social quotient on the Vineland Social Maturity Scale, and scores on the Child Behavior Checklist and the Pediatric Quality of Life Inventory. RESULTS At 12 months, freedom from seizures occurred in 44 patients (77%) in the surgery group and in 4 (7%) in the medical-therapy group (P<0.001). Between-group differences in the change from baseline to 12 months significantly favored surgery with respect to the score on the Hague Seizure Severity scale (difference, 19.4; 95% confidence interval [CI], 15.8 to 23.1; P<0.001), on the Child Behavior Checklist (difference, 13.1; 95% CI, 10.7 to 15.6; P<0.001), on the Pediatric Quality of Life Inventory (difference, 21.9; 95% CI, 16.4 to 27.6; P<0.001), and on the Vineland Social Maturity Scale (difference, 4.7; 95% CI, 0.4 to 9.1; P=0.03), but not on the Binet-Kamat intelligence quotient (difference, 2.5; 95% CI, -0.1 to 5.1; P=0.06). Serious adverse events occurred in 19 patients (33%) in the surgery group, including hemiparesis in 15 (26%). CONCLUSIONS In this single-center trial, children and adolescents with drug-resistant epilepsy who had undergone epilepsy surgery had a significantly higher rate of freedom from seizures and better scores with respect to behavior and quality of life than did those who continued medical therapy alone at 12 months. Surgery resulted in anticipated neurologic deficits related to the region of brain resection. (Funded by the Indian Council of Medical Research and others; Clinical Trial Registry-India number, CTRI/2010/091/000525 .).
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Affiliation(s)
- Rekha Dwivedi
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Bhargavi Ramanujam
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - P Sarat Chandra
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Savita Sapra
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Sheffali Gulati
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Chandra S Bal
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Sada N Dwivedi
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sagar
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Chitra Sarkar
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- From the Departments of Neurology (R.D., B.R., Manjari Tripathi), Neurosurgery (P.S.C.), Pediatrics (S.S., S.G.), Biostatistics (M.K., S.N.D.), Neuro-Radiology (A.G.), Nuclear Medicine (C.S.B., Madhavi Tripathi), Psychiatry (R.S.), and Pathology (C.S.), All India Institute of Medical Sciences, New Delhi, India
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Chaudhary K, Ramanujam B, Kumaran SS, Chandra PS, Wadhawan AN, Garg A, Tripathi M. Does education play a role in language reorganization after surgery in drug refractory temporal lobe epilepsy: An fMRI based study? Epilepsy Res 2017; 136:88-96. [PMID: 28802988 DOI: 10.1016/j.eplepsyres.2017.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Patients with drug refractory epilepsy (DRE) and a high level of education may differ in their language recovery after surgery. Our aim was to determine whether there were differences in the extent of improvement and pattern of reorganization of language functions on functional magnetic resonance imaging (fMRI) after surgery to treat refractory temporal lobe epilepsy (TLE) between patients with more than 12 years of formal education versus those with a shorter period of regular schooling. METHODS After approval by an institutional ethics committee, 60 right-handed, adult patients of left TLE and 20 right-handed, healthy controls were recruited to the study. Multiple aspects of language (Repetition, Naming, Word fluency, Visual word and Comprehension reading) were tested using the Indian Aphasia Battery (IAB) in the Hindi language; fMRI was performed using a standardized Hindi language paradigm (lexical, semantic, syntactic and comprehension components) in both cases and controls, before and after an anterior temporal lobectomy (in cases) with a 1.5T MR Scanner. An array of performance tests of intelligence and the verbal adult intelligence scale (VAIS) were used to measure the Intelligence Quotient (IQ) in Left TLE (LTLE) patients before and after surgery. Language laterality was estimated using the laterality index (LI-toolbox-spm8). Cohen's d test was performed to determine the effect sizes of the differences in the IAB scores, and Pearson's correlation was applied between regional (IFG and STG) activation in controls and TLE patients with more than 12 years of schooling [higher educational status (HES subgroup)] and those with less than 12 years of schooling [lower educational status (LES subgroup)]. RESULTS At the baseline, clinical testing with IAB showed better scores in controls than in cases. Better scores were observed in subjects with higher levels of education than in those with lower levels of education. An improvement was observed in IQ scores in both the HES and LES groups after ATLR; significant worsening in the abstract ability subtest was noted in the LES group, whereas in the HES group there was an improvement. Blood-oxygen-level dependent (BOLD) activation during language tasks was observed in both cerebral hemispheres in the TLE cases, while it was observed in the traditional left hemispheric language areas in controls. Postoperatively, greater BOLD activation was observed in the left inferior frontal gyri (IFG, r=0.65*; p<0.05), middle frontal gyrus (MFG, r=0.77**; p<0.01) superior temporal gyri (STG, r=0.88* p<0.02) and angular gyrus (AG, r=0.73*; p<0.04) in HES compared to LES subjects. Similarly, LI showed left lateralization of the frontal (LIw=0.77 & 0.71) and temporal (LIw=0.74 & 0.5) regions in controls and the TLE group (post-surgery) compared to the pre-surgery group during language tasks. CONCLUSIONS Greater improvement in language skills and BOLD activation in the left hemisphere in TLE-patients (after epilepsy surgery) with a high level of education was similar to that of healthy controls, implying that education has an effect on the functional reorganization/recovery of language areas.
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Affiliation(s)
- Kapil Chaudhary
- Department of Neurology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Bhargavi Ramanujam
- Department of Neurology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - S Senthil Kumaran
- Department of NMR and MRI Facility, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Ashima Nehra Wadhawan
- Department of Clinical Neuropsychology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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Thounaojam R, Langbang L, Itisham K, Sobhani R, Srivastava S, Ramanujam B, Verma R, Tripathi M, Aguan K. EFHC1 mutation in Indian juvenile myoclonic epilepsy patient. Epilepsia Open 2017; 2:84-89. [PMID: 29750216 PMCID: PMC5939392 DOI: 10.1002/epi4.12037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2016] [Indexed: 12/21/2022] Open
Abstract
Objective Juvenile myoclonic epilepsy (JME) is the most common form of idiopathic generalized epilepsies (IGEs) and is genetically heterogeneous. Mutations in EFHC1 cause JME. Because about 2 million people in India are affected by JME alone, we investigated the prevalence of mutations in the EFHC1 gene in the Indian population with JME. We studied 63 patients with JME and 80 healthy controls. Methods Clinical identification of JME was evaluated using established criteria. Following clinical evaluation of the patients and confirming presence of JME, blood samples were collected from each patient and healthy individual. Subsequently, genomic DNA was extracted from the blood samples. Eleven exons of the EFHC1 gene were individually amplified by polymerase chain reaction (PCR) for each DNA sample. The PCR products were then purified and sequenced commercially. The identified DNA variants were sequenced at least twice in both the forward and reverse directions and compared with the Exome Aggregation Consortium (ExAC) database. Results We found five heterozygous and one homozygous variant. We found three novel coding variants 661C→T, 779 G →A, and 730 C→T, which lead to R221C, R260Q, and R244STOP amino acid substitutions, respectively. The coding variant 475 C→T, resulting in the amino acid substitution R159W, reported earlier as polymorphism, was also identified in both patient and control populations. Significance Detection of these three novel variants, excluding R159W, which is considered polymorphism, expands the range of possible mutations in the EFHC1 gene. The novel variants that we are reporting herein have not been mentioned before as occurring in JME patients of other ethnic population. Therefore, these novel coding variants may be confined to the Indian JME population. Further studies on the mutational spectrum of EFHC1 in a larger number of Indian JME patients concurrent with their mode of inheritance and underlying functional assays should establish whether EFHC1 could be a panethnic gene for JME.
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Affiliation(s)
- Romita Thounaojam
- Department of Biotechnology and Bioinformatics North Eastern Hill University (NEHU) Shillong India
| | - Leader Langbang
- Department of Biotechnology and Bioinformatics North Eastern Hill University (NEHU) Shillong India
| | - Kavish Itisham
- Department of Neurology Neurosciences Centre All India Institute of Medical Sciences (AIIMS) New Delhi India
| | - Roohollah Sobhani
- Department of Biotechnology and Bioinformatics North Eastern Hill University (NEHU) Shillong India
| | - Shivani Srivastava
- Department of Neurology Neurosciences Centre All India Institute of Medical Sciences (AIIMS) New Delhi India
| | - Bhargavi Ramanujam
- Department of Neurology Neurosciences Centre All India Institute of Medical Sciences (AIIMS) New Delhi India
| | - Ramesh Verma
- Department of Neurology Neurosciences Centre All India Institute of Medical Sciences (AIIMS) New Delhi India
| | - Manjari Tripathi
- Department of Neurology Neurosciences Centre All India Institute of Medical Sciences (AIIMS) New Delhi India
| | - Kripamoy Aguan
- Department of Biotechnology and Bioinformatics North Eastern Hill University (NEHU) Shillong India
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Ramanujam B, Bharti K, Viswanathan V, Garg A, Tripathi M, Bal C, Chandra PS, Tripathi M. Can ictal-MEG obviate the need for phase II monitoring in people with drug-refractory epilepsy? A prospective observational study. Seizure 2017; 45:17-23. [DOI: 10.1016/j.seizure.2016.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/23/2016] [Accepted: 10/16/2016] [Indexed: 10/20/2022] Open
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Chaudhari RM, Dash D, Ramanujam B, Rana MK, Appukuttan R, Sharma A, Kunwar Y, Tejaniya G, Padma V, Chandra SP, Tripathi M. Evaluation of Ictal Consciousness in Temporal and Extra Temporal Epilepsy: Observations from a Tertiary Care Hospital in India. J Epilepsy Res 2017; 6:93-96. [PMID: 28101481 PMCID: PMC5206106 DOI: 10.14581/jer.16017] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/25/2016] [Indexed: 11/09/2022] Open
Abstract
Background and Purpose Differences in consciousness during seizures depend on the location of the seizure onset. Methods The present study evaluates ictal consciousness using the ictal consciousness inventory (ICI) in drug refractory mesial temporal (MTLE), neocortical temporal (NTLE) and extra temporal epilepsy (ETLE). This was a cross sectional cohort study with 45 patients with mesial temporal epilepsy, 47 with extra temporal and 11 patients with neocortical temporal epilepsy. The ICI a 20 item questionnaire was used to calculate the scores for level (L, question 1–10) and content (C, question 11–20) of consciousness. Results The patients in mesial temporal group had higher ICI-L scores, p = 0.0129 as compared to the extra temporal group, but no difference was observed in the content of consciousness. The ICI-L and C scores were not different in the mesial temporal and the neocortical temporal group (p = 0.53 and 0.65) respectively. Conclusions Patients with mesial temporal epilepsy had a higher level of consciousness than the extra temporal group but there was no difference in the content. Also there was no difference in the level and content of consciousness between mesial and the neocortical temporal group.
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Affiliation(s)
- Rima M Chaudhari
- Department of Neurology, All India Institute of Medical sciences, New Delhi, India
| | - Deepa Dash
- Department of Neurology, All India Institute of Medical sciences, New Delhi, India
| | - Bhargavi Ramanujam
- Department of Neurology, All India Institute of Medical sciences, New Delhi, India
| | - Manit K Rana
- Department of Neurology, All India Institute of Medical sciences, New Delhi, India
| | - Renjith Appukuttan
- Department of Neurology, All India Institute of Medical sciences, New Delhi, India
| | - Anubha Sharma
- Department of Neurology, All India Institute of Medical sciences, New Delhi, India
| | - Yuvraj Kunwar
- Department of Neurology, All India Institute of Medical sciences, New Delhi, India
| | - Gaurav Tejaniya
- Department of Neurology, All India Institute of Medical sciences, New Delhi, India
| | - Vasantha Padma
- Department of Neurology, All India Institute of Medical sciences, New Delhi, India
| | - Sarat P Chandra
- Department of Neurosurgery, All India Institute of Medical sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical sciences, New Delhi, India
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Chaudhari RM, Ramanujam B, Appukuttan R, Sharma A, Kunwar Y, Tejaniya G, Garg A, Padma MV, Tripathi M, Bal C, Dash D, Chandra SP, Tripathi M. Utility of a questionnaire tool (QUARAS) for localizing and lateralizing seizures in the epilepsy monitoring unit (EMU). Clin Neurol Neurosurg 2017; 153:64-66. [PMID: 28043024 DOI: 10.1016/j.clineuro.2016.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 11/21/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES An accurate description of the seizure semiology improves the recognition of the ictal onset zone and helps in hypothesizing the possible epileptogenic zone (EZ). Semiology based on a reliable description of seizures may be as good as investigative modalities, as has been shown by numerous studies. The main objective of this study was to apply a questionnaire-tool for auras and semiology (QUARAS) in refractory epilepsy cohort and compare its yield to that of standard history-taking. METHODS A drug refractory epilepsy cohort of 139 subjects was selected, based on inclusion and exclusion criteria. All subjects underwent routine history-taking, and a structured interview with QUARAS (in Hindi language) about 3-6 months later when they were admitted for pre-surgical work-up (Video-EEG, MRI, SPECT and PET), by an epilepsy nurse. Seizures were localised and lateralised at the each step separately, in a blinded manner; concordance with the final hypothesis was checked, after the epilepsy-surgery case-conference, and statistical significance of the difference calculated. RESULTS Auras were reported in significantly more number of patients after administration of QUARAS (p<0.001); there was also higher concordance between the final hypothesis and the localization and lateralization based on QUARAS than an unstructured history (p<0.001). CONCLUSION Administering a structured questionnaire in the native language of patients by trained personnel leads to better localisation and lateralisation and may help arrive at a hypothesis about the EZ.
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Affiliation(s)
- Rima M Chaudhari
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhargavi Ramanujam
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Renjith Appukuttan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Anubha Sharma
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Yuvraj Kunwar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Tejaniya
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrashekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Deepa Dash
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Sarat P Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
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Srivastava S, Ramanujam B, Ihtisham K, Tripathi M. Cutaneous Adverse Drug Reactions to Lamotrigine and Human Leukocyte Antigen Typing in North Indian Patients: A Case Series. Ann Indian Acad Neurol 2017; 20:408-410. [PMID: 29184346 PMCID: PMC5682747 DOI: 10.4103/aian.aian_234_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cutaneous adverse drug reaction (cADR) has limited epidemiological data in India. The older antiepileptic drugs, i.e., carbamazepine, phenytoin, valproic acid, phenobarbitone, etc., induce severe cADRs that have a strong associated with human leukocyte antigen (HLA)-related genetic risk factors. There is also evidence of association of certain HLA alleles with lamotrigine (LTG)-induced cADRs, but this has not been reported in the Indian population. Here, we report case series of three patients with LTG-induced “Stevens-Johnson syndrome (SJS).” Their HLA-B typing was also performed which showed the presence of HLA-B*15:02 in one case with SJS.
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Affiliation(s)
- Shivani Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhargavi Ramanujam
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kavish Ihtisham
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Ramanujam B, Ihtisham K, Kaur G, Srivastava S, Mehra NK, Khanna N, Singh M, Tripathi M. Spectrum of Cutaneous Adverse Reactions to Levetiracetam and Human Leukocyte Antigen Typing in North-Indian Patients. J Epilepsy Res 2016; 6:87-92. [PMID: 28101480 PMCID: PMC5206105 DOI: 10.14581/jer.16016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/05/2016] [Indexed: 12/17/2022] Open
Abstract
Background and Purpose Aromatic antiepileptic drugs are frequently implicated for cutaneous adverse drug reactions (cADRs); there are case-reports of even severe reactions like drug reaction eosinophilia and systemic symptoms (DRESS) and Stevens Johnson syndrome (SJS)-toxic epidermal necrolysis with Levetiracetam (LEV). Certain human leukocyte antigen (HLA)-alleles have strong association with cADRs due to specific drugs - HLA-B*15:02 and HLA-A*31:01 in Carbamazepine (CBZ)-related SJS in Han-Chinese and European populations, respectively. Here, the spectrum of cADRs to LEV was studied, and HLA-typing in patients with cADRs due to LEV and some who were LEV-tolerant was performed, in an attempt to find an association between HLA and such reactions. Methods 589 patients taking LEV were screened for skin reactions, and eight patients with LEV-related cADRs and 25 LEV-tolerant controls were recruited - all 33 of North Indian ethnicity, their HLA-A, B, DRB1 genotyping done. Statistical analysis was done to compare carrier-rates and allele-frequencies of HLA-alleles between cases and controls (and healthy population, where necessary) for alleles occurring more than two times in either group. Results Out of 589 patients on LEV screened, there were 8 cases of cADR: 5 with maculopapular exanthema (MPE), 2 of SJS, and 1 with DRESS. Although HLA-A*33:01 was seen to occur more in MPE cases as compared to tolerant controls, the difference was not statistically significant (odds ratio [OR] 6.00, 95% confidence interval [CI] 0.30–116.6; p = 0.31). HLA A*11:01 and 24:02 were found to occur more in LEV-tolerant controls than in cases (OR 0.23 [95% CI 0.02–2.36, p = 0.33] and 1.00 [95% CI 0.09–11.02, p = 1.00] respectively). Conclusions Cutaneous reactions to LEV are very unusual, and their association with HLA in North-Indian population was not statistically significant.
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Affiliation(s)
- Bhargavi Ramanujam
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kavish Ihtisham
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Gurvinder Kaur
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
| | - Shivani Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Narinder Kumar Mehra
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Khanna
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Mahip Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Renuka S, Ramanujam B, Poornesha B. Endophytic Ability of Different Isolates of Entomopathogenic Fungi Beauveria bassiana (Balsamo) Vuillemin in Stem and Leaf Tissues of Maize (Zea mays L.). Indian J Microbiol 2016; 56:126-33. [PMID: 27570303 DOI: 10.1007/s12088-016-0574-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 03/11/2016] [Indexed: 11/28/2022] Open
Abstract
The present study was conducted to examine the ability of six promising indigenous isolates of Beauveria bassiana (NBAII-Bb-5a, 7, 14, 19, 23 and 45) as an endophyte in maize stem and leaf tissues. Maize seedlings (var. Nithyashree) were inoculated with conidial suspensions and were examined for endophytic establishment in leaf and stems at different intervals during 15-90 days after treatment. All six isolates showed colonization in stem and leaf tissues with varying abilities of colonization and persistence. The mean percent colonization ranged from 7.41 to 20.37 % in older stem tissues and 3.70 to 21.29 % in young stem tissues and in leaf, it ranged from 6.46 to 27.78 % in older leaf tissues and 11.11 to 26.85 % in young leaf tissues. Among six isolates tested, Bb-23 isolate recorded the maximum mean colonization in older stem (20.37 %), older leaf (27.78 %) and in young stem (21.29 %). Bb-5a isolate showed maximum mean colonization in young leaf tissues (26.85 %). Persistence of inoculated fungal isolates decreased with increase in age of the plant. No physical symptoms of damage were observed in any of the B. bassiana treated plants. No colonization of B. bassiana was observed in the untreated control maize plants. The results obtained in plating and PCR techniques were similar with regard to the confirmation of endophytic establishment of B. bassiana. This study indicated the possibility of using B. bassiana as an endophyte in maize for management of maize stem borer, Chilo partellus.
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Affiliation(s)
- S Renuka
- Division of Ecology and Behavior, National Bureau of Agricultural Important Insect Resources, P.O. Box. 2491, H.A. Farm Post, Bellary Road, Hebbal, Bengaluru, Karnataka 560024 India
| | - B Ramanujam
- Division of Ecology and Behavior, National Bureau of Agricultural Important Insect Resources, P.O. Box. 2491, H.A. Farm Post, Bellary Road, Hebbal, Bengaluru, Karnataka 560024 India
| | - B Poornesha
- Division of Ecology and Behavior, National Bureau of Agricultural Important Insect Resources, P.O. Box. 2491, H.A. Farm Post, Bellary Road, Hebbal, Bengaluru, Karnataka 560024 India
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Abstract
Primary angiitis of central nervous system (PACNS) is characterized by non-caseating granulomatous angiitis restricted to CNS. The condition often masquerades as migraine, stroke, epilepsy, dementia, demyelinating disorder and CNS infection. The protean manifestations frequently lead to misdiagnoses. We present a case of a young male from rural background that remained undiagnosed for years as the possibility of PACNS was not considered. He had history suggestive of migraine-like headaches followed by seizures. Subsequently, he developed rapidly progressive dementia and two episodes of hemorrhagic strokes over a short period. The diagnosis was finally clinched by the absence of evidence of systemic vasculitis and the presence of characteristic non-caseating granuloma around vessels of duramater and cerebral parenchyma on brain biopsy. He was started on pulse therapy with intravenous cyclophosphamide and methylprednisolone. The current literature about the condition and its management is reviewed in this report.
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Affiliation(s)
- Bhupender Kumar Bajaj
- Department of Neurology, Post Graduate Institute of Medical Education and Research (PGIMER), Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Shweta Pandey
- Department of Neurology, Post Graduate Institute of Medical Education and Research (PGIMER), Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Bhargavi Ramanujam
- Department of Neurology, Post Graduate Institute of Medical Education and Research (PGIMER), Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Ankur Wadhwa
- Department of Neurology, Post Graduate Institute of Medical Education and Research (PGIMER), Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Ramanujam B, Dash D, Dabla S, Tripathi M, Srivastava MVP. Epilepsia Partialis Continua as Presenting Manifestation of AIDS: A Rarity. J Int Assoc Provid AIDS Care 2015; 15:19-22. [PMID: 25667167 DOI: 10.1177/2325957415570743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/17/2022] Open
Abstract
Seizures, most commonly generalized tonic-clonic, are common in known human immune deficiency virus (HIV) sero-positive patients, and they usually have a focal lesion on brain imaging. However, it is very unusual to see a patient with no premorbid illness presenting with epilepsia partialis continua (EPC) and then being detected HIV seropositive with an Acquired Immune Deficiency Syndrome (AIDS)-defining illness. We report the case of a teenaged boy with no past significant history or known high-risk behavior who presented with recurrent focal seizures of 5 days' duration, EPC, and encephalopathy. His electroencephalogram showed periodic lateralized epileptiform discharges (PLEDS), and magnetic resonance imaging (MRI) of the brain showed abnormal signal changes in the right parieto-occipital cortex and thalamus, both as yet unreported in cytomegalovirus (CMV) encephalitis, which was diagnosed by the cerebrospinal fluid (CSF) analysis.
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Affiliation(s)
- Bhargavi Ramanujam
- Neurology Department, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Deepa Dash
- Neurology Department, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Surekha Dabla
- Department of Medicine, B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Manjari Tripathi
- Neurology Department, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - M V Padma Srivastava
- Neurology Department, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Ramanujam B, Rangeshwaran R, Sivakumar G, Mohan M, Yandigeri MS. Management of Insect Pests by Microorganisms. Proceedings of the Indian National Science Academy 2014. [DOI: 10.16943/ptinsa/2014/v80i2/3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Derakhshan A, Rabindra RJ, Ramanujam B, Rahimi M. Evaluation of different media and methods of cultivation on the production and viability of entomopathogenic fungi, Verticillium lecanii (Zimm.) Viegas. Pak J Biol Sci 2008; 11:1506-9. [PMID: 18817256 DOI: 10.3923/pjbs.2008.1506.1509] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
For mass production of V. lecanii, three types of cultivation methods including liquid, solid and diphasic production systems were investigated. In the liquid state of production, six media were tested in stationary culture conditions. Among the six media tested, Molasses Yeast Broth (MYB) supported maximum sporulation (8.33 x 10(8) spores mL(-1)) and biomass production (746 mg/100 mL). In the MYB, 4% molasses concentration was found to produce highest spore count (8.56 x 10(8) spores mL(-1)) and biomass (776 mg/100 mL) followed by 5 and 6% molasses. Among the six solid substrates tested, rice grains supported highest spore production (1.14 g/100 g). In diphasic state of production, combination of MYB and rice grains produced the greatest amount of spores, (1.70 g/100 g). Results of this study indicated that diphasic method using MYB as liquid medium and rice as solid substrate are the best method and media for mass production of V1-7 isolate of V. lecanii.
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Affiliation(s)
- Ali Derakhshan
- Department of Plant Protection, College of Agriculture, Shahrood University of Technology, Shahrood, Iran
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