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Gupta A, Goyal A, Rajan R, Vishnu VY, Kalaivani M, Tandon N, Srivastava MVP, Gupta Y. Validity of Montreal Cognitive Assessment to Detect Cognitive Impairment in Individuals with Type 2 Diabetes. Diabetes Ther 2024; 15:1155-1168. [PMID: 38520603 PMCID: PMC11043253 DOI: 10.1007/s13300-024-01549-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/06/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION Guidelines recommend screening older people (> 60-65 years) with type 2 diabetes (T2D) for cognitive impairment, as it has implications in the management of diabetes. The Montreal Cognitive Assessment (MoCA) is a sensitive test for the detection of mild cognitive impairment (MCI) in the general population, but its validity in T2D has not been established. METHODS We administered MoCA to patients with T2D (age ≥ 60 years) and controls (no T2D), along with a culturally validated neuropsychological battery and functional activity questionnaire. MCI was defined as performance in one or more cognitive domains ≥ 1.0 SD below the control group (on two tests representing a cognitive domain), with preserved functional activities. The discriminant validity of MoCA for the diagnosis of MCI at different cut-offs was ascertained. RESULTS We enrolled 267 patients with T2D and 120 controls; 39% of the participants with T2D met the diagnostic criteria for MCI on detailed neuropsychological testing. At the recommended cut-off on MoCA (< 26), the sensitivity (94.2%) was high, but the specificity was quite low (29.5%). The cut-off score of < 23 showed an optimal trade-off between sensitivity (69.2%), specificity (71.8%), and diagnostic accuracy (70.8%). The cut-off of < 21 exhibited the highest diagnostic accuracy (74.9%) with an excellent specificity (91.4%), a good positive and negative predictive value (78.5% and 73.7%, respectively). CONCLUSIONS The recommended screening cut-off point on MoCA of < 26 has a suboptimal specificity and may increase the referral burden in memory clinics. A lower cut-off of < 21 on MoCA maximizes the diagnostic accuracy. Interactive Visual Abstract available for this article.
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Affiliation(s)
- Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Alpesh Goyal
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | - Yashdeep Gupta
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Kishore A, Sturm M, Soman Pillai K, Hakkaart C, Kalikavil Puthanveedu D, Urulangodi M, Krishnan S, Ashok Kumar Sreelatha A, Rajan R, Pal PK, Yadav R, Sarma G, Casadei N, Gasser T, Bauer P, Riess O, Sharma M. Resequencing the complete SNCA locus in Indian patients with Parkinson's disease. NPJ Parkinsons Dis 2024; 10:85. [PMID: 38622158 PMCID: PMC11018851 DOI: 10.1038/s41531-024-00676-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 02/29/2024] [Indexed: 04/17/2024] Open
Abstract
The genetic loci implicated in familial Parkinson's disease (PD) have limited generalizability to the Indian PD population. We tested mutations and the frequency of known mutations in the SNCA gene in a PD cohort from India. We selected 298 PD cases and 301 age-matched controls for targeted resequencing (before QC), along with 363 PD genomes of Indian ancestry and 1029 publicly available whole genomes from India as healthy controls (IndiGenomes), to determine the frequency of monogenic SNCA mutations. The raw sequence reads were analyzed using an in-house analysis pipeline, allowing the detection of small variants and structural variants using Manta. The in-depth analysis of the SNCA locus did not identify missense or structural variants, including previously identified SNCA mutations, in the Indian population. The familial forms of SNCA gene variants do not play a major role in the Indian PD population and this warrants further research in the under-represented population.
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Affiliation(s)
- Asha Kishore
- Comprehensive Care Centre for Movement Disorders, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kochi, Kerala, India
- Parkinson and Movement Disorder Centre, Centre for Excellence in Neurosciences, Aster Medcity, Kochi, Kerala, India
| | - Marc Sturm
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Kanchana Soman Pillai
- Parkinson and Movement Disorder Centre, Centre for Excellence in Neurosciences, Aster Medcity, Kochi, Kerala, India
| | - Christopher Hakkaart
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Divya Kalikavil Puthanveedu
- Comprehensive Care Centre for Movement Disorders, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kochi, Kerala, India
| | - Madhusoodanan Urulangodi
- Comprehensive Care Centre for Movement Disorders, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kochi, Kerala, India
| | - Syam Krishnan
- Comprehensive Care Centre for Movement Disorders, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kochi, Kerala, India
| | - Ashwin Ashok Kumar Sreelatha
- Centre for Genetic Epidemiology, Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | - Roopa Rajan
- Department of Neurology, All India Institute for Medical Sciences, New Delhi, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gangadhara Sarma
- Comprehensive Care Centre for Movement Disorders, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kochi, Kerala, India
| | - Nicolas Casadei
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Thomas Gasser
- Department for Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Peter Bauer
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- Centogene GmbH, Rostock, Germany
- University Medicine Rostock, Internal Medicine III, Hematology, Rostock, Germany
| | - Olaf Riess
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Manu Sharma
- Centre for Genetic Epidemiology, Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany.
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3
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Radhakrishnan DM, Saini A, Fatima S, Gupta A, Vishnu VY, Singh MB, Bhatia R, Srivastva MP, Srivastava AK, Rajan R. Primary Coenzyme Q10 Deficiency-4 Causing Young Onset Ataxia-Dystonia. Mov Disord Clin Pract 2024; 11:438-440. [PMID: 38556906 PMCID: PMC10982600 DOI: 10.1002/mdc3.13950] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 04/02/2024] Open
Affiliation(s)
| | - Arti Saini
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Saman Fatima
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Anu Gupta
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Mamta Bhushan Singh
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Rohit Bhatia
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Achal K. Srivastava
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Roopa Rajan
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
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Saini A, Holla VV, Kalikavil Puthanveedu D, Mehta S, Elavarasi A, Pillai KS, Mohapatra P, Kumari R, Bari S, Singh I, Cherian A, Krishnan S, Radhakrishnan DM, Agarwal A, Garg D, Garg K, Singh M, Garg A, Muthusamy B, Lal V, Kishore A, Pal PK, Srivastava A, Faruq M, Rajan R. Novel PANK2 Variant in Asian Indians with Atypical Pantothenate Kinase Associated Neurodegeneration. Mov Disord 2024. [PMID: 38506547 DOI: 10.1002/mds.29737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/02/2023] [Accepted: 01/16/2024] [Indexed: 03/21/2024] Open
Affiliation(s)
- Arti Saini
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vikram V Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Divya Kalikavil Puthanveedu
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Sahil Mehta
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Kanchana Soman Pillai
- Parkinson and Movement Disorder Centre, Centre for Excellence in Neurosciences, Aster Medcity, Kochi, India
| | - Prachi Mohapatra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Riyanka Kumari
- Institute of Bioinformatics, Bengaluru, India
- Manipal Academy of Higher Education, Manipal, India
| | - Shreya Bari
- Council of Scientific and Industrial Research-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Inder Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajith Cherian
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Syam Krishnan
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Divyani Garg
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Babylakshmi Muthusamy
- Institute of Bioinformatics, Bengaluru, India
- Manipal Academy of Higher Education, Manipal, India
| | - Vivek Lal
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Asha Kishore
- Parkinson and Movement Disorder Centre, Centre for Excellence in Neurosciences, Aster Medcity, Kochi, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Achal Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Mohammed Faruq
- Council of Scientific and Industrial Research-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Mishra B, Sudheer P, Rajan R, Agarwal A, Srivastava MVP, Nilima N, Vishnu VY. Bridging the gap between statistical significance and clinical relevance: A systematic review of minimum clinically important difference (MCID) thresholds of scales reported in movement disorders research. Heliyon 2024; 10:e26479. [PMID: 38439837 PMCID: PMC10909673 DOI: 10.1016/j.heliyon.2024.e26479] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/16/2024] [Accepted: 02/14/2024] [Indexed: 03/06/2024] Open
Abstract
Background Minimum clinically important difference (MCID) is the smallest change in an outcome measure that is considered clinically meaningful. Using validated MCID thresholds for outcomes powers trials adequately to detect meaningful treatment effects, aids in their interpretation and guides development of new outcome measures. Objectives To provide a comprehensive summary of MCID thresholds of various symptom severity scales reported in movement disorder. Methods We conducted systematic review of the literature and included studies of one or more movement disorders, and reporting MCID scales. Results 2763 reports were screened. Final review included 32 studies. Risk of bias (RoB) assessment showed most studies were of good quality. Most commonly evaluated scale was Unified Parkinson's Disease Rating Scale (UPDRS) (11 out of 32). Four studies assessing MDS-UPDRS had assessed its different sub-parts, reporting a change of 2.64,3.05,3.25 and 0.9 points to detect clinically meaningful improvement and 2.45,2.51,4.63 and 0.8 points to detect clinically meaningful worsening, for the Part I, II, III and IV, respectively. For Parts II + III, I + II + III and I + II + III + IV, MCID thresholds reported for clinically meaningful improvement were 5.73, 4.9, 6.7 and 7.1 points respectively; while those for clinically meaningful worsening were 4.7, 4.2, 5.2 and 6.3 points, respectively. MCID thresholds reported for other scales included Abnormal Involuntary Movement Scale (AIMS), Toronto Western Spasmodic Torticollis Rating Scale (TWSRS), and Burke-Fahn-Marsden Dystonia Scale (BFMD). Conclusion This review summarizes all the MCID thresholds currently reported in Movement disorders research and provides a comprehensive resource for future trials, highlighting the need for standardized and validated MCID scales in movement disorder research.
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Affiliation(s)
- Biswamohan Mishra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pachipala Sudheer
- 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
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Nilima Nilima
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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6
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Agarwal S, Sebastian LJD, Gaikwad S, Srivastava MVP, Sharma MC, Singh M, Bhatia R, Agarwal A, Sharma J, Dash D, Goyal V, Srivastava AK, Tripathi M, Suri V, Singh MB, Sarkar C, Suri A, Singh RK, Vibha D, Pandit AK, Rajan R, Gupta A, Elavarasi A, Radhakrishnan DM, Das A, Tandon V, Doddamani R, Upadhyay A, Vishnu VY, Garg A. The role of susceptibility-weighted imaging & contrast-enhanced MRI in the diagnosis of primary CNS vasculitis: a large case series. Sci Rep 2024; 14:4718. [PMID: 38413676 PMCID: PMC10899183 DOI: 10.1038/s41598-024-55222-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/21/2024] [Indexed: 02/29/2024] Open
Abstract
Primary CNS Vasculitis (PCNSV) is a rare, diverse, and polymorphic CNS blood vessel inflammatory condition. Due to its rarity, clinical variability, heterogeneous imaging results, and lack of definitive laboratory markers, PCNSV diagnosis is challenging. This retrospective cohort analysis identified patients with histological diagnosis of PCNSV. Demographic data, clinical presentation, neuroimaging studies, and histopathologic findings were recorded. We enrolled 56 patients with a positive biopsy of CNS vasculitis. Most patients had cerebral hemisphere or brainstem symptoms. Most brain MRI lesions were bilateral, diffuse discrete to confluent white matter lesions. Frontal lobe lesions predominated, followed by inferior cerebellar lesions. Susceptibility-weighted imaging (SWI) hemorrhages in 96.4% (54/56) of patients, either solitary microhemorrhages or a combination of micro and macrohemorrhages. Contrast-enhanced T1-WIs revealed parenchymal enhancement in 96.3% (52/54 patients). The most prevalent pattern of enhancement observed was dot-linear (87%), followed by nodular (61.1%), perivascular (25.9%), and patchy (16.7%). Venulitis was found in 19 of 20 individuals in cerebral DSA. Hemorrhages in SWI and dot-linear enhancement pattern should be incorporated as MINOR diagnostic criteria to diagnose PCNSV accurately within an appropriate clinical context. Microhemorrhages in SWI and venulitis in DSA, should be regarded as a potential marker for PCNSV.
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Affiliation(s)
- Sushant Agarwal
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Shailesh Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- 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
| | - Jyoti Sharma
- 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
| | - Vinay Goyal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Achal K 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
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta B Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Chitra Sarkar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- 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
| | - Deepti Vibha
- 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
| | - Roopa Rajan
- 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
| | - A Elavarasi
- 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
| | - Vivek Tandon
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Doddamani
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
| | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India.
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Rajan R, Anandapadmanabhan R, Vishnoi A, Latorre A, Thirugnanasambandam N, Dipani A, Biswas D, Radhakrishnan DM, Srivastava A, Bhatia KP. Essential Tremor and Essential Tremor Plus Are Essentially Similar Electrophysiologically. Mov Disord Clin Pract 2024; 11:136-142. [PMID: 38386479 PMCID: PMC10883406 DOI: 10.1002/mdc3.13941] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/25/2023] [Accepted: 11/10/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The merits of classifying the heterogeneous group of essential tremors into essential tremor (ET) and essential tremor plus (ETP) are debated. OBJECTIVES We studied the electrophysiological and spiral characteristics of tremor in ET and ETP. METHODS We reviewed standardized videos from a tremor database and clinically classified patients into ET, ETP, or dystonic tremor (DT). The following variables were derived from combined tri-axial accelerometry-surface electromyography (EMG)-peak frequency, total power, peak power, full width half maximum, tremor stability index and EMG-coherence. We analyzed hand-drawn spirals to derive mean deviation, tremor variability, inter-, and intra-loop widths. We compared these variables among the groups. RESULTS We recruited 72 participants (81.9% male) with mean age 47.7 ± 16.1 years and Fahn-Tolosa-Marin Tremor Rating Scale total score 31.1 ± 14.1. Patients with ET were younger (P = 0.014) and had less severe tremor (P = 0.020) compared to ETP and DT. In ETP group, 48.6% had subtle dystonia. Peak frequency was greater in ETP (7.3 ± 0.3 Hz) compared to DT (6.1 ± 0.4 Hz; P = 0.024). Peak power was greater in ETP and DT for postural tremor. Rest tremor was recordable on accelerometry in 26.7% of ET. Other variables were similar among the groups. CONCLUSION Electrophysiological evaluation revealed postural tremor of frequency 6 to 7 Hz in ET, ETP, and DT with subtle differences more severe tremor in ETP and DT, and higher frequency in ETP compared to DT. Our findings suggest a similar tremor oscillator in these conditions, supporting the view that these entities are part of a spectrum of tremor disorders, rather than distinct etiological entities.
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Affiliation(s)
- Roopa Rajan
- All India Institute of Medical Sciences (AIIMS)New DelhiIndia
| | | | - Aayushi Vishnoi
- All India Institute of Medical Sciences (AIIMS)New DelhiIndia
| | - Anna Latorre
- University College London Hospitals (UCL)LondonUnited Kingdom
| | | | - Alish Dipani
- National Brain Research Centre (NBRC)ManesarIndia
| | - Deblina Biswas
- All India Institute of Medical Sciences (AIIMS)New DelhiIndia
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Rai S, Bharti PS, Singh R, Rastogi S, Rani K, Sharma V, Gorai PK, Rani N, Verma BK, Reddy TJ, Modi GP, Inampudi KK, Pandey HC, Yadav S, Rajan R, Nikolajeff F, Kumar S. Circulating plasma miR-23b-3p as a biomarker target for idiopathic Parkinson's disease: comparison with small extracellular vesicle miRNA. Front Neurosci 2023; 17:1174951. [PMID: 38033547 PMCID: PMC10684698 DOI: 10.3389/fnins.2023.1174951] [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: 02/27/2023] [Accepted: 04/24/2023] [Indexed: 12/02/2023] Open
Abstract
Background Parkinson's disease (PD) is an increasingly common neurodegenerative condition, which causes movement dysfunction and a broad range of non-motor symptoms. There is no molecular or biochemical diagnosis test for PD. The miRNAs are a class of small non-coding RNAs and are extensively studied owing to their altered expression in pathological states and facile harvesting and analysis techniques. Methods A total of 48 samples (16 each of PD, aged-matched, and young controls) were recruited. The small extracellular vesicles (sEVs) were isolated and validated using Western blot, transmission electron microscope, and nanoparticle tracking analysis. Small RNA isolation, library preparation, and small RNA sequencing followed by differential expression and targeted prediction of miRNA were performed. The real-time PCR was performed with the targeted miRNA on PD, age-matched, and young healthy control of plasma and plasma-derived sEVs to demonstrate their potential as a diagnostic biomarker. Results In RNA sequencing, we identified 14.89% upregulated (fold change 1.11 to 11.04, p < 0.05) and 16.54% downregulated (fold change -1.04 to -7.28, p < 0.05) miRNAs in PD and controls. Four differentially expressed miRNAs (miR-23b-3p, miR-29a-3p, miR-19b-3p, and miR-150-3p) were selected. The expression of miR-23b-3p was "upregulated" (p = 0.002) in plasma, whereas "downregulated" (p = 0.0284) in plasma-derived sEVs in PD than age-matched controls. The ROC analysis of miR-23b-3p revealed better AUC values in plasma (AUC = 0.8086, p = 0.0029) and plasma-derived sEVs (AUC = 0.7278, p = 0.0483) of PD and age-matched controls. Conclusion We observed an opposite expression profile of miR-23b-3p in PD and age-matched healthy control in plasma and plasma-derived sEV fractions, where the expression of miR-23b-3p is increased in PD plasma while decreased in plasma-derived sEV fractions. We further observed the different miR-23b-3p expression profiles in young and age-matched healthy control.
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Affiliation(s)
- Sanskriti Rai
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rishabh Singh
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India
| | - Simran Rastogi
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India
| | - Komal Rani
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences Bibinagar, Hyderabad, India
| | - Vaibhav Sharma
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Priya Kumari Gorai
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Rani
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Bhupendra Kumar Verma
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Gyan Prakash Modi
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology BHU, Varanasi, India
| | | | - Hem Chandra Pandey
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Yadav
- Department of Biochemistry, All India Institute of Medical Sciences Raebareli, Uttar Pradesh, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Fredrik Nikolajeff
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Saroj Kumar
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
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Garg D, Agarwal A, Garg A, Rajan R, Srivastava AK. 'Comb Sign': A Novel Appearance of Substantia Nigra in Mitochondrial Membrane Protein-Associated Neurodegeneration. Ann Indian Acad Neurol 2023; 26:1004-1005. [PMID: 38229644 PMCID: PMC10789401 DOI: 10.4103/aian.aian_608_23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 01/18/2024] Open
Affiliation(s)
- Divyani Garg
- 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
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Rajan R, Vishnu VY, Latorre A, Bhatia KP. Reply to: Pregabalin Responsive Tongue and Arm Tremor after Guillain Barré Syndrome. Mov Disord Clin Pract 2023; 10:1707-1708. [PMID: 37982120 PMCID: PMC10654821 DOI: 10.1002/mdc3.13891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 11/21/2023] Open
Affiliation(s)
- Roopa Rajan
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Anna Latorre
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College London (UCL) Institute of NeurologyLondonUnited Kingdom
| | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College London (UCL) Institute of NeurologyLondonUnited Kingdom
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Rastogi S, Rani K, Rai S, Singh R, Bharti PS, Sharma V, Sahu J, Kapoor V, Vishwakarma P, Garg S, Gholap SL, Inampudi KK, Modi GP, Rani N, Tripathi M, Srivastava A, Rajan R, Nikolajeff F, Kumar S. Fluorescence-tagged salivary small extracellular vesicles as a nanotool in early diagnosis of Parkinson's disease. BMC Med 2023; 21:335. [PMID: 37667227 PMCID: PMC10478478 DOI: 10.1186/s12916-023-03031-1] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/15/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Parkinson's disease is generally asymptomatic at earlier stages. At an early stage, there is an extensive progression in the neuropathological hallmarks, although, at this stage, diagnosis is not possible with currently available diagnostic methods. Therefore, the pressing need is for susceptibility risk biomarkers that can aid in better diagnosis and therapeutics as well can objectively serve to measure the endpoint of disease progression. The role of small extracellular vesicles (sEV) in the progression of neurodegenerative diseases could be potent in playing a revolutionary role in biomarker discovery. METHODS In our study, the salivary sEV were efficiently isolated by chemical precipitation combined with ultrafiltration from subjects (PD = 70, healthy controls = 26, and prodromal PD = 08), followed by antibody-based validation with CD63, CD9, GAPDH, Flotillin-1, and L1CAM. Morphological characterization of the isolated sEV through transmission electron microscopy. The quantification of sEV was achieved by fluorescence (lipid-binding dye-labeled) nanoparticle tracking analysis and antibody-based (CD63 Alexa fluor 488 tagged sEV) nanoparticle tracking analysis. The total alpha-synuclein (α-synTotal) in salivary sEVs cargo was quantified by ELISA. The disease severity staging confirmation for n = 18 clinically diagnosed Parkinson's disease patients was done by 99mTc-TRODAT-single-photon emission computed tomography. RESULTS We observed a significant increase in total sEVs concentration in PD patients than in the healthy control (HC), where fluorescence lipid-binding dye-tagged sEV were observed to be higher in PD (p = 0.0001) than in the HC using NTA with a sensitivity of 94.34%. In the prodromal PD cases, the fluorescence lipid-binding dye-tagged sEV concentration was found to be higher (p = 0.008) than in HC. This result was validated through anti-CD63 tagged sEV (p = 0.0006) with similar sensitivity of 94.12%. We further validated our findings with the ELISA based on α-synTotal concentration in sEV, where it was observed to be higher in PD (p = 0.004) with a sensitivity of 88.24%. The caudate binding ratios in 99mTc-TRODAT-SPECT represent a positive correlation with sEV concentration (r = 0.8117 with p = 0.0112). CONCLUSIONS In this study, for the first time, we have found that the fluorescence-tagged sEV has the potential to screen the progression of disease with clinically acceptable sensitivity and can be a potent early detection method for PD.
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Affiliation(s)
- Simran Rastogi
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Komal Rani
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, 110029, India
- Department of Pathology & Laboratory Medicine, All India Institute of Medical Sciences Bibinagar, Hyderabad, 508126, India
| | - Sanskriti Rai
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rishabh Singh
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Prahalad Singh Bharti
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vaibhav Sharma
- Department of Health, Education, and Technology, Luleå University of Technology, 97187, Luleå, Sweden
| | - Jyoti Sahu
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vrinda Kapoor
- School of Interdisciplinary Research, Indian Institute of Technology Delhi, New Delhi, 110016, India
| | - Poorvi Vishwakarma
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sumit Garg
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | | | - Gyan Prakash Modi
- Department of Pharmaceutical Engineering & Technology, Indian Institute of Technology BHU, Varanasi, 221005, India
| | - Neerja Rani
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Achal Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Fredrik Nikolajeff
- Department of Health, Education, and Technology, Luleå University of Technology, 97187, Luleå, Sweden
| | - Saroj Kumar
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, 110029, India.
- Department of Health, Education, and Technology, Luleå University of Technology, 97187, Luleå, Sweden.
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12
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Quattrone A, Latorre A, Magrinelli F, Mulroy E, Rajan R, Neo RJ, Quattrone A, Rothwell JC, Bhatia KP. A Reflection on Motor Overflow, Mirror Phenomena, Synkinesia and Entrainment. Mov Disord Clin Pract 2023; 10:1243-1252. [PMID: 37772299 PMCID: PMC10525069 DOI: 10.1002/mdc3.13798] [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: 03/14/2023] [Revised: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 09/30/2023] Open
Abstract
In patients with movement disorders, voluntary movements can sometimes be accompanied by unintentional muscle contractions in other body regions. In this review, we discuss clinical and pathophysiological aspects of several motor phenomena including mirror movements, dystonic overflow, synkinesia, entrainment and mirror dystonia, focusing on their similarities and differences. These phenomena share some common clinical and pathophysiological features, which often leads to confusion in their definition. However, they differ in several aspects, such as the body part showing the undesired movement, the type of this movement (identical or not to the intentional movement), the underlying neurological condition, and the role of primary motor areas, descending pathways and inhibitory circuits involved, suggesting that these are distinct phenomena. We summarize the main features of these fascinating clinical signs aiming to improve the clinical recognition and standardize the terminology in research studies. We also suggest that the term "mirror dystonia" may be not appropriate to describe this peculiar phenomenon which may be closer to dystonic overflow rather than to the classical mirror movements.
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Affiliation(s)
- Andrea Quattrone
- Institute of NeurologyUniversity “Magna Graecia”CatanzaroItaly
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Francesca Magrinelli
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Roopa Rajan
- Department of NeurologyAll India Institute of Medical Sciences (AIIMS)New DelhiIndia
| | - Ray Jen Neo
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
- Department of NeurologyHospital Kuala LumpurKuala LumpurMalaysia
| | - Aldo Quattrone
- Neuroscience Research Center, Department of Medical and Surgical SciencesUniversity “Magna Graecia”CatanzaroItaly
| | - John C. Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Kailash P. Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
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13
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Pillai KS, Misra S, Siripurapu G, Aliyar A, Bhat P, Rajan R, Srivastava A, Goyal V, Venkitachalam A, Radhakrishnan DM. De Novo Movement Disorders Associated with COVID-19- A Systematic Review of Individual Patients. Ann Indian Acad Neurol 2023; 26:702-707. [PMID: 38022478 PMCID: PMC10666879 DOI: 10.4103/aian.aian_572_23] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/28/2023] [Accepted: 08/14/2023] [Indexed: 12/01/2023] Open
Abstract
Background COVID-19 infection is associated with neurological manifestations, including various types of movement disorders (MD). A thorough review of individual patients with COVID-19-induced MD would help in better understanding the clinical profile and outcome of these patients and in prognostication. Objective We conducted an individual patient-systematic review to study the clinical and imaging profile and outcomes of patients with COVID-19-associated MD. Methods A systematic literature search of PubMed, EMBASE, and Cochrane databases was conducted by two independent reviewers. Individual patient data COVID from case reports and case series on COVID-19-associated MD, published between December 2019 and December 2022, were extracted and analyzed. Results Data of 133 patients with COVID-19-associated MD from 82 studies were analyzed. Mean age was 55 ± 18 years and 77% were males. A mixed movement disorder was most commonly seen (41%); myoclonus-ataxia was the most frequent (44.4%). Myoclonus significantly correlated with age (odds ratio (OR) 1.02 P = 0.03, CI 1-1.04). Tremor had the longest latency to develop after SARS-CoV-2 infection [median (IQR) 21 (10-40) days, P = 0.009, CI 1.01-1.05]. At short-term follow-up, myoclonus improved (OR 14.35, P value = 0.01, CI 1.71-120.65), whereas parkinsonism (OR 0.09, P value = 0.002, CI 0.19-0.41) and tremor (OR 0.16, P value = 0.016, CI 0.04-0.71) persisted. Conclusion Myoclonus-ataxia was the most common movement disorder after COVID-19 infection. Myoclonus was seen in older individuals and usually improved. Tremor and parkinsonism developed after a long latency and did not improve in the short-term.
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Affiliation(s)
- Kanchana S. Pillai
- Department of Neurology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Shubham Misra
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Govinda Siripurapu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Aminu Aliyar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Bhat
- 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
| | - Achal Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Goyal
- Institute of Neurosciences, Medanta the Medicity, Gurugram, Haryana, India
| | - Anil Venkitachalam
- Department of Neurology, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
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14
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Rajan R, Anandapadmanabhan R, Vishnoi A, Vishnu VY, Latorre A, Agarwal H, Ghosh T, Mangat N, Biswas D, Gupta A, Radhakrishnan DM, Singh MB, Bhatia R, Srivastava A, Srivastava MVP, Bhatia KP. Neuropathic Tremor in Guillain-Barré Syndrome. Mov Disord Clin Pract 2023; 10:1333-1340. [PMID: 37772292 PMCID: PMC10525049 DOI: 10.1002/mdc3.13807] [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] [Received: 12/06/2022] [Revised: 05/12/2023] [Accepted: 05/24/2023] [Indexed: 09/30/2023] Open
Abstract
Background Neuropathic Tremor (NT) is a postural/kinetic tremor of the upper extremity, often encountered in patients with chronic neuropathies such as paraprotein-associated and hereditary neuropathies. Objectives To describe the clinical and electrophysiological features of NT in a previously underrecognized setting- during recovery from Guillain-Barré Syndrome (GBS). Methods Patients with a documented diagnosis of GBS in the past, presenting with tremor were identified from review of clinical records. Participants underwent structured, videotaped neurological examination, and electrophysiological analysis using tri-axial accelerometry-surface electromyography. Tremor severity was assessed using the Fahn-Tolosa-Marin Tremor Rating Scale. Results We describe the clinical and electrophysiological features of 5 patients with GBS associated NT. Our cohort had a fine, fast, and slightly jerky postural tremor of frequency ranging from 8 to 10 Hz. Dystonic posturing and overflow movements were noted in 4/5 patients. Tremor appeared 3 months-5 years after the onset of GBS, when patients had regained near normal muscle strength and deep tendon jerks were well elicitable. Electrophysiological analysis of tremor strongly suggested the presence of a central oscillator in all patients. Conclusion NT is not limited to chronic inflammatory or hereditary neuropathies and may occur in the recovery phase of GBS. The tremor is characterized by a high frequency, jerky postural tremor with dystonic posturing. Electrophysiological evaluation suggests the presence of a central oscillator, hypothetically the cerebellum driven by impaired sensorimotor feedback.
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Affiliation(s)
- Roopa Rajan
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Aayushi Vishnoi
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Anna Latorre
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College London (UCL) Institute of NeurologyLondonUnited Kingdom
| | - Harsh Agarwal
- All Indian Institute of Medical SciencesNew DelhiIndia
| | | | - Navtej Mangat
- All Indian Institute of Medical SciencesNew DelhiIndia
| | - Deblina Biswas
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Anu Gupta
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Mamta Bhushan Singh
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Rohit Bhatia
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Achal Srivastava
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College London (UCL) Institute of NeurologyLondonUnited Kingdom
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15
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Agarwal A, Makkar AM, Garg A, Tripathi M, Vishnu VY, Rajan R, Singh MB, Bhatia R, Srivastava MVP, Gupta A. Granulin-FTLD Presenting as Mixed Transcortical Aphasia: New Kid on the Block? Ann Indian Acad Neurol 2023; 26:819-822. [PMID: 38022440 PMCID: PMC10666881 DOI: 10.4103/aian.aian_164_23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/12/2023] [Accepted: 07/30/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush M. Makkar
- 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
| | | | - Roopa Rajan
- 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
| | - M. V. P. Srivastava
- 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
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16
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Sahib A, Bhatia R, Srivastava MVP, Singh MB, Komakula S, Vishnu VY, Rajan R, Gupta A, Srivastava AK, Wig N, Vikram NK, Biswas A. Escalate: Linezolid as an add on treatment in the intensive phase of tubercular meningitis. A randomized controlled pilot trial. Tuberculosis (Edinb) 2023; 142:102351. [PMID: 37394301 DOI: 10.1016/j.tube.2023.102351] [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: 02/13/2023] [Revised: 05/03/2023] [Accepted: 05/21/2023] [Indexed: 07/04/2023]
Abstract
Most drugs used in the treatment of Tuberculous Meningitis have limited CNS penetration thereby limiting efficacy. CSF penetration of linezolid is 80-100%.The study was a prospective, randomized, open label with blinded outcome assessment pilot trial carried out in patients with TBM. Patients were randomized in a 1:1 ratio into two treatment groups either to receive standard ATT alone or add on oral 600 mg BD Linezolid for 4 weeks along with standard four drug ATT [HRZE/S]. Primary outcome was safety and mortality at the end of one and three months measured by intention to treat analysis. 29 patients were recruited and 27 completed three months of follow up. There was no significant difference in terms of mortality with Odds ratio (95% CI) of 2 (0.161-24.87; p = 1) at one month and 0.385 (0.058-2.538; p = 0.39) at three months. There was a significant improvement in GCS in Linezolid group at one month and mRS within the Linezolid group at one and three months. No major safety concerns were observed. The sample size is underpowered to draw any definitive conclusions but improvement in mRS and GCS as well as mortality change make a case for a large sample size trial.
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Affiliation(s)
- Akhil Sahib
- 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.
| | - M V Padma Srivastava
- 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
| | - Snigdha Komakula
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - V Y Vishnu
- 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
| | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naval K Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashutosh Biswas
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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17
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Gupta A, Rajan R, Joy S, Yadav CS, Tripathi M, Gaikwad SB, Vishnu VY, Singh MB, Bhatia R, Mahadevan A, Srivastava MVP. Neuronal Antibody-Associated Corticobasal Syndrome. Ann Indian Acad Neurol 2023; 26:787-789. [PMID: 38022470 PMCID: PMC10666851 DOI: 10.4103/aian.aian_560_23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Anu Gupta
- 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
| | - Shiny Joy
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shailesh B. Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - VY 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
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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18
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Agarwal A, Garg D, Rajan R, Srivastava AK, Garg A. Wishbone Sign in GM1 Type III Gangliosidosis. Ann Indian Acad Neurol 2023; 26:558-559. [PMID: 37970291 PMCID: PMC10645235 DOI: 10.4103/aian.aian_530_23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Divyani Garg
- 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
| | - Achal K. Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
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19
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Saini G, Malhotra S, Rajan R, Vishnu VY, Mani K, Bhatia R, Bhushan M, Srivastava MVP, Gupta A. Video Teleconference Administration of the Addenbrooke's Cognitive Examination-III for the Assessment of Neuropsychological Status: An Experience in Indian Subjects with Cognitive Dysfunction. Ann Indian Acad Neurol 2023; 26:447-452. [PMID: 37970289 PMCID: PMC10645197 DOI: 10.4103/aian.aian_97_23] [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: 02/02/2023] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 11/17/2023] Open
Abstract
Objective To determine the feasibility, reliability, and acceptability of video teleconference (VTC)-based neuropsychological assessment using Addenbrooke's cognitive examination-III (ACE-III). Methods This study was performed from January 2022 to April 2022, during the third wave of the COVID-19 pandemic in India. We administered ACE-III using video-teleconferencing and compared the scores to face-to-face (FTF) testing for the eligible participants. We also conducted a participant's satisfaction survey of VTC-administered ACE-III compared to FTF-administered ACE-III, using a 7-point Likert scale. Results We screened 37 participants and 24 (64.9%) successfully underwent ACE-III testing through VTC. We included 20 patients (mean age: 62.7 ± 10 years, mean education: 12.0 ± 4.6 years, 85% men) for final analysis, (who completed both VTC and FTF-administered ACE-III). Nine patients had major neurocognitive disorder (dementia), eight had mild neurocognitive disorder (MCI), and three had subjective cognitive decline (SCD). The two tests were administered at a median gap of 36 (18,74.5) days. The Intraclass correlation coefficients (ICC) of ACE-3 total scores (0.97) and the subdomain scores was high (>0.8). There was "very low" to "no" bias on the Bland-Altman plots, across all domains. The mean overall satisfaction score was 4.1, indicating that VTC is "as good as" FTF. Conclusions Results support the feasibility and acceptability of remote administration of ACE-III via VTC. There is a good agreement between the ACE-III scores across VTC and in-person conditions.
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Affiliation(s)
- Garima Saini
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Simran Malhotra
- 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
| | | | - Kalaivani Mani
- Department of Biostatistics, 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
- 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
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Bhartiya M, Kumar A, Singh RK, Radhakrishnan DM, Rajan R, Srivastava AK. Mesenchymal Stem Cell Therapy in the Treatment of Neurodegenerative Cerebellar Ataxias: a Systematic Review and Meta-analysis. Cerebellum 2023; 22:363-369. [PMID: 35451803 DOI: 10.1007/s12311-022-01403-6] [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] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 04/25/2023]
Abstract
The objective of this study is to synthesise the findings of clinical studies in order to derive evidence for use of the mesenchymal stem cell (MSC) therapy in the treatment of neurodegenerative cerebellar ataxias. In order to find relevant studies for the systematic review, we searched through Medline (1985 to July 2020), PubMed and Clinical trial register. We included both single-arm and comparative studies in which MSCs were given as intervention in neurodegenerative ataxia patients at any time after the diagnosis. We used Joanna Briggs Institute (JBI) quality scale to evaluate the methodological qualities of the included studies. Our literature search obtained 81 publications. Three articles comprising a total of 47 patients were included in the meta-analysis. None of them were randomised controlled trials (RCTs). Pooled analysis noted that there was a decrease in the Berg Balance Scale (BBS)/Scale for the Assessment and Rating of Ataxia (SARA) score from pre to post assessment; however, the difference was statistically not significant (standardised mean difference (SMD) - 0.20; 95% CI - 0.78 to 0.38). No significant side effects were reported in any of the studies. We did not observe any statistically significant difference in the pooled mean difference in the International Cooperative Ataxia Rating Scale (ICARS) score between pre and post assessment in patients with ataxia after receiving the stem cells (SMD 0.36, 95% CI - 0.08 to 0.81). Our systematic review and meta-analysis concluded that MSC cell therapy appeared safe but provided insufficient evidence to support the use of MSCs to treat patients with neurodegenerative cerebellar ataxia at present. No l RCTs was available in the literature to test efficacy; therefore, well-designed RCTs are needed to ascertain the effectiveness of MSCs in patients with neurodegenerative cerebellar ataxias.
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Affiliation(s)
- Manish Bhartiya
- Department of Neurology, CN Centre, All India Institute of Medical Sciences, Room No. 60 GF, New Delhi, 110029, India
| | - Amit Kumar
- Department of Neurology, CN Centre, All India Institute of Medical Sciences, Room No. 60 GF, New Delhi, 110029, India
| | - Rakesh K Singh
- Department of Neurology, CN Centre, All India Institute of Medical Sciences, Room No. 60 GF, New Delhi, 110029, India
| | - Divya M Radhakrishnan
- Department of Neurology, CN Centre, All India Institute of Medical Sciences, Room No. 60 GF, New Delhi, 110029, India
| | - Roopa Rajan
- Department of Neurology, CN Centre, All India Institute of Medical Sciences, Room No. 60 GF, New Delhi, 110029, India
| | - Achal Kumar Srivastava
- Department of Neurology, CN Centre, All India Institute of Medical Sciences, Room No. 60 GF, New Delhi, 110029, India.
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Valentijn PP, Eggers C, Bloem BR, Grimes D, Goldman J, McGinley J, Gardner J, Piemonte MEP, Dahodwala N, Brennan L, Iansek R, Kovacs N, Parashos S, Hilel A, Rajan R. Validation of the Rainbow Model of Integrated Care Measurement Tool in Parkinson's Disease. Mov Disord 2023. [PMID: 37148424 DOI: 10.1002/mds.29413] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/11/2023] [Accepted: 04/04/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Integrated care is essential for improving the management and health outcomes for people with Parkinson's disease (PD); reliable and objective measures of care integration are few. OBJECTIVE The aim of this study was to test the psychometric properties of the Rainbow Model of Integrated Care Measurement Tool (RMIC-MT, provider version) for healthcare professionals involved in PD care. METHODS A cross-sectional survey was administered online to an international network representing 95 neurology centers across 41 countries and 588 healthcare providers. Exploratory factor analysis with principal axis extraction method was used to assess construct validity. Confirmatory factor analysis was used to evaluate model fit of the RMIC-MT provider version. Cronbach's alpha was used to assess the internal consistency reliability. RESULTS Overall, 371 care providers (62% response rate) participated in this study. No item had psychometric sensitivity problems. Nine factors (professional coordination, cultural competence, triple aims outcome, system coordination, clinical coordination, technical competence, community-centeredness, person-centeredness, and organizational coordination) with 42 items were determined by exploratory factor analysis. Cronbach's alpha ranged from 0.76 (clinical coordination) to 0.94 (system coordination) and showed significant correlation among all items in the scale (>0.4), indicating good internal consistency reliability. The confirmatory factor analysis model passed most goodness-of-fit tests, thereby confirming the factor structure of nine categories with a total of 40 items. CONCLUSIONS The results provide evidence for the construct validity and other psychometric properties of the provider version of the RMIC-MT to measure integrated care in PD. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Pim P Valentijn
- Department of Health Services Research, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, the Netherlands
| | - Carsten Eggers
- Department of Neurology, University Hospital of Marburg, Center for Mind, Brain and Behavior, Universities Marburg and Giessen, Marburg, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Bastiaan R Bloem
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - David Grimes
- Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jennifer Goldman
- Parkinson's and Movement Disorders Shirley Ryan Ability Lab and Departments of Physical Medicine and Rehabilitation and Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Departments of Physical Medicine and Rehabilitation and Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer McGinley
- Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia
| | - Joan Gardner
- Struthers Parkinson's Center, HealthPartners, Minneapolis, Minnesota, USA
| | | | - Nabila Dahodwala
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laura Brennan
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Robert Iansek
- Clinical Research Centre for Movement Disorders and Gait, Comprehensive Parkinson Care Program, Parkinson Foundation Centre of Excellence, Kington Centre Monash Health Cheltenham, Cheltenham, Australia
| | - Norbert Kovacs
- Department of Neurology, Medical School, University of Pecs, Pecs, Hungary
- ELKH-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary
| | - Sotirios Parashos
- Struthers Parkinson's Center, HealthPartners, Minneapolis, Minnesota, USA
| | - Ariela Hilel
- Movement Disorders Center Unit, Neurology Division, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Gotur AJ, Prasad K, Bhatia R, Srivastava AK, Tripathi M, Goyal V, Pandit AK, Vibha D, Rajan R, Padma Srivastava MV. Rivastigmine for Cognitive Impairment in Multiple Sclerosis: A Prospective Randomized Open Label study with Blinded End-Point Assessment. Neurol India 2023; 71:514-521. [PMID: 37322749 DOI: 10.4103/0028-3886.378694] [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: 06/17/2023]
Abstract
Background and Objective Nearly 40-65% patients with MS develop cognitive impairment during the disease. There is no treatment clearly effective in improving the cognitive deficits. To evaluate the efficacy and safety of Rivastigmine in cognitively impaired MS patients. Materials and Methods This was a parallel group randomized open label study with blinded end-point assessment. The patient allocation to treatment and control arm was done by telephonic contact with an independent statistician who used a computer to generate a random sequence of allocation using permuted block randomization (varying block size of 4 and 6) in 1:1 ratio. The outcome assessor was blinded to this allocation. A total of 60 patients were in included in the study (30 in each arm). Primary outcome was improvement in memory functions (using logical memory subset of Wechsler Memory Scale III, India) assessed after 12 weeks. Secondary outcomes included fatigue, depression, and safety. Results In modified intention to treat analysis (N = 22), treatment arm showed statistically significant improvement in memory function with mean difference of 7.56 [95% CI (0.67,14.46), p 0.032] as compared to control arm. There was no statistically significant difference in outcomes such as fatigue and depression. Vomiting was the most common side effect. No major adverse events were observed in either group. Conclusion Rivastigmine is safe and effective in improving memory functions in cognitively impaired MS patients. However, our study has a small sample size and tested only a single domain. Larger studies with a validated single comprehensive neuropsychological test are needed.
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Affiliation(s)
- Amrita J Gotur
- Department of Neurology, Neurosciences Centre, AIIMS, New Delhi, India
| | - Kameshwar Prasad
- Director and Chief Executive Officer, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Rohit Bhatia
- Department of Neurology, Neurosciences Centre, AIIMS, New Delhi, India
| | | | - Manjari Tripathi
- Department of Neurology, Neurosciences Centre, AIIMS, New Delhi, India
| | - Vinay Goyal
- Department of Neurology, Neurosciences Institute, Medanta - The Medicity, Gurugram, Haryana, India
| | - Awadh K Pandit
- Department of Neurology, Neurosciences Centre, AIIMS, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, Neurosciences Centre, AIIMS, New Delhi, India
| | - Roopa Rajan
- Department of Neurology, Neurosciences Centre, AIIMS, New Delhi, India
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23
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Painous C, Martí MJ, Graessner H, Camargo AP, El-Jaafary SI, Martínez-Ramírez D, Ojo OO, Taiwo FT, Rajan R, Cornejo-Olivas M, Ayele BA, Tibar H, Kearney M, Gatto E, Tijssen MA. Management of rare movement diseases in different world regions. Parkinsonism Relat Disord 2023; 108:105286. [PMID: 36669905 DOI: 10.1016/j.parkreldis.2023.105286] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 01/15/2023]
Abstract
To evaluate the management of rare movement disorders (RMD) at the international level and identify care needs to be addressed, the Rare Movement Disorders Study Group of the International Parkinson and Movement Disorders Society (MDS) has conducted an exploratory survey. We sent an online survey to experts in Africa, Asia, Oceania and American continents following the classification of the MDS Regional Sections: Africa, Asia and Oceania (A&O), and Pan-America. We did not include Europe as the European Reference Network for Rare Neurological Diseases recently performed a similar care needs survey across European countries. We obtained responses from experts from 20 African, 26 A&O and 19 Pan-American countries. According to the respondents, only 55% of African countries had movement disorders experts, while these were present in 96% of A&O and 91% of Pan-American. Access to care for patients with RMD was stated difficult in 70% of African, 54% of A&O, and 65% of Pan-American countries. Africa was the region with greatest difficulties in accessing diagnostic tests. However, in Pan-America and A&O, large inequalities were observed between countries with quite variable access to therapeutic options such as deep brain stimulation. The survey results reflect wide variability in the management of RMD and provide evidence that a worldwide care-focused network is highly warranted. Scientific and medical organisations should raise awareness of deficits in managing RMD and care disparities among regions. The goals should be to facilitate the training of professionals, establish improvement strategies, and increase support and budgeting for these diseases.
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Affiliation(s)
- Celia Painous
- Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Catalonia Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED: CB06/05/0018-ISCIII), Barcelona, Spain
| | - Maria J Martí
- Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Catalonia Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED: CB06/05/0018-ISCIII), Barcelona, Spain
| | - Holm Graessner
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany; Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Andrea Paola Camargo
- Fundación universitaria ciencias de la salud, Hospital de San José, Bogotá, Colombia
| | - Shaimaa Ibrahim El-Jaafary
- Neurology Department, Cairo University, Egypt; Global Brain Health Institute.Trinity College Dublin, Ireland
| | | | - Oluwadamilola O Ojo
- Neurology Unit, Department of Medicine, College of Medicine of the University of Lagos & Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Mario Cornejo-Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, Lima, Peru; Carrera de Medicina, Universidad Científica del Sur, Lima, Peru
| | - Biniyam A Ayele
- Department of Neurology, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Houyam Tibar
- Service de Neurologie B et de Neurogénétique, Hôpital des spécialités OTO-Neuro-Ophtalmologique. Ibn Sina University Hospital Mohamed 5 University, Medical School of Rabat, Rabat, Morocco
| | - Mary Kearney
- Irish College of General Practitioners and Primary Care Physician, Dublin, Ireland; ERN-RND European Patient Advocacy Group Representatives, Germany
| | - Emilia Gatto
- Department of Neurology, Sanatorio de la Trinidad Mite. Department of Parkinson's Disease and Movement Disorders, INEBA Affiliated University of Buenos Aires, Buenos Aires, Argentina
| | - Marina Aj Tijssen
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Siripurapu G, Verma B, Biswas D, Reghu A, Vishnoi A, Radhakrishnan DM, Elavarasi A, Gupta A, Vishnu VY, Singh MB, Bhatia R, Tripathi M, Srivastava A, Srivastava MVP, Rajan R. Social Cognition in Parkinson's Disease: A Case-Control Study. Mov Disord Clin Pract 2023; 10:399-405. [PMID: 36949784 PMCID: PMC10026278 DOI: 10.1002/mdc3.13653] [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] [Received: 04/18/2022] [Revised: 11/19/2022] [Accepted: 12/13/2022] [Indexed: 12/31/2022] Open
Abstract
Background Social cognition is the study of how people make sense of themselves and others. Impairment in several domains of social cognition is increasingly being recognized in Parkinson's disease (PD). Objectives We aimed to study multiple domains of social cognition in Indian PD patients using a culturally appropriate, validated instrument. Methods We recruited 52 individuals with PD and 31 healthy volunteers (HV) and used the Social Cognition Rating Tools in Indian Setting (SOCRATIS) tool to assess theory of mind (ToM), attributional biases and social cue perception. Quality of life (QoL) was assessed using the PDQOL scale. Results Baseline characteristics were comparable between PD and HV. The mean (SD) FOT index (first order ToM index) was 0.86(0.18) in PD and 0.99(0.07) in HV [P < 0.001]. The PD group showed higher Externalizing Bias [EB, 4.42(3.91)], compared to HV [1.58(3.22), P = 0.001]. The mean (SD) Faux Pas Composite Index (FPCI ALT) was 0.69(0.09) in PD and 0.78(0.13) in HV [P < 0.001]. Social cognition indices were not associated with QoL in PD. Clinical parameters-age, gender, HAM-D, MOCA, education, levodopa equivalent daily dose of medication, number of PD drugs and trihexyphenidyl use did not predict social cognition. Conclusion PD patients were less successful than age, gender matched controls in understanding social situations and other's thought processes and had higher tendency to attribute undesirable events to external causes. Deficits in social cognition did not impair the quality of life.
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Affiliation(s)
- Govinda Siripurapu
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Bhawna Verma
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Deblina Biswas
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Aayushi Vishnoi
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | | | - Anu Gupta
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Mamta Bhushan Singh
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Rohit Bhatia
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Manjari Tripathi
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Achal Srivastava
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Roopa Rajan
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
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25
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Chatterpal P, Radhakrishnan DM, Garg A, Tripathi M, Rajan R, Agarwal A, Pandit AK, Srivastava AK. PSP-Like Phenotype in Genetically Confirmed SCA12. Mov Disord Clin Pract 2023; 10:326-328. [PMID: 36989015 PMCID: PMC9941930 DOI: 10.1002/mdc3.13590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/08/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Pinky Chatterpal
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Ajay Garg
- Department of Neuroimaging & Interventional NeuroradiologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Madhavi Tripathi
- Department of Nuclear MedicineAll India Institute of Medical SciencesNew DelhiIndia
| | - Roopa Rajan
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Ayush Agarwal
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Awadh K. Pandit
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Achal K. Srivastava
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
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Nehra A, Makkar R, Singh RK, Rajan R, Khan MA, Srivastava AK. Is disease a threat to identity? A systematic review of parkinson's disease and personal identity. Indian J Public Health 2023; 67:117-122. [PMID: 37039216 DOI: 10.4103/ijph.ijph_1283_22] [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: 04/12/2023] Open
Abstract
Introduction Parkinson's disease (PD) is a neurological condition that impacts the physical and psychological functioning of the patients. The physical and cognitive changes come with social stigma and threats to roles previously associated with their identities. Objectives The current paper attempts to study the influence of the disease on the personal identity of the patients. Methods A systematic review was done on PD and personal identity following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The Consolidated Criteria for Reporting Qualitative Research checklist was used to assess the quality of the papers. The selected papers were synthesized to understand the relationship between PD and personal identity. Results The emerging themes were: (1) dissociation of old personal identity: (1.1) Influence of physical symptoms, (1.2) influence of society and stigma, and (1.3) threats to roles associated with identity and (2) changing family dynamics. A Model of Personal, Family, and Disease Dynamics was also developed based on clinical first-hand experience with the patients and the review. Conclusion The personal identity of the PD patients shifts drastically as a result of their physical and psychosocial experiences. This also results in changed family dynamics, with the patient feeling sidelined due to loss of control and responsibilities in the family.
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Affiliation(s)
- Ashima Nehra
- Professor, Clinical Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rhythm Makkar
- Research Fellow, Clinical Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumar Singh
- Associate Professor, Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Rajan
- Associate Professor, Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Maroof Ahmad Khan
- Professor, Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Achal Kumar Srivastava
- Professor, Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Sehrawat P, Gupta A, Garg A, Vishnu V, Rajan R, Bhatia R, Singh MB, Srivastava MVP. Adult-Onset Adrenoleukodystrophy Presenting With Atypical Location of White Matter Lesions. Neurology 2022; 99:1051-1052. [PMID: 36180238 DOI: 10.1212/wnl.0000000000201437] [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] [Received: 03/28/2022] [Accepted: 09/06/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Priyanka Sehrawat
- From the Department of Neurology (P.S.R., A.G.P., V.V., R.R.P., R.B., M.B.S., M.V.P.S.), All India Institute of Medical Sciences, New Delhi; and Department of Neuroradiology (A.G.), All India Institute of Medical Sciences, New Delhi
| | - Anu Gupta
- From the Department of Neurology (P.S.R., A.G.P., V.V., R.R.P., R.B., M.B.S., M.V.P.S.), All India Institute of Medical Sciences, New Delhi; and Department of Neuroradiology (A.G.), All India Institute of Medical Sciences, New Delhi.
| | - Ajay Garg
- From the Department of Neurology (P.S.R., A.G.P., V.V., R.R.P., R.B., M.B.S., M.V.P.S.), All India Institute of Medical Sciences, New Delhi; and Department of Neuroradiology (A.G.), All India Institute of Medical Sciences, New Delhi
| | - Venugopalan Vishnu
- From the Department of Neurology (P.S.R., A.G.P., V.V., R.R.P., R.B., M.B.S., M.V.P.S.), All India Institute of Medical Sciences, New Delhi; and Department of Neuroradiology (A.G.), All India Institute of Medical Sciences, New Delhi
| | - Roopa Rajan
- From the Department of Neurology (P.S.R., A.G.P., V.V., R.R.P., R.B., M.B.S., M.V.P.S.), All India Institute of Medical Sciences, New Delhi; and Department of Neuroradiology (A.G.), All India Institute of Medical Sciences, New Delhi
| | - Rohit Bhatia
- From the Department of Neurology (P.S.R., A.G.P., V.V., R.R.P., R.B., M.B.S., M.V.P.S.), All India Institute of Medical Sciences, New Delhi; and Department of Neuroradiology (A.G.), All India Institute of Medical Sciences, New Delhi
| | - Mamta Bhushan Singh
- From the Department of Neurology (P.S.R., A.G.P., V.V., R.R.P., R.B., M.B.S., M.V.P.S.), All India Institute of Medical Sciences, New Delhi; and Department of Neuroradiology (A.G.), All India Institute of Medical Sciences, New Delhi
| | - M V Padma Srivastava
- From the Department of Neurology (P.S.R., A.G.P., V.V., R.R.P., R.B., M.B.S., M.V.P.S.), All India Institute of Medical Sciences, New Delhi; and Department of Neuroradiology (A.G.), All India Institute of Medical Sciences, New Delhi
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Pillai KS, Bhat P, Srivastava AK, Rajan R, Radhakrishnan DM, Elavarasi A, Srivastava MP, Singh MB, Vishnu VY, Prasad K, Pandit AK, Goyal V. Zonisamide add-on in tremor-dominant Parkinson's disease- A randomized controlled clinical trial. Parkinsonism Relat Disord 2022; 105:1-6. [PMID: 36323130 DOI: 10.1016/j.parkreldis.2022.10.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION and objective: Tremor is a disabling symptom of PD that usually responds poorly to available standard pharmacological agents. This study aimed to assess the effect of Zonisamide 25 mg on tremor in tremor-dominant PD patients as compared to placebo. METHODS This was a randomized, placebo-controlled, double-blind study. Parkinson's disease patients were allocated either to the intervention group (standard treatment along with Zonisamide 25 mg add-on) or the placebo group (standard treatment along with placebo). Baseline Unified Parkinson's Disease Rating Scale (UPDRS) and Tremor Research Group Essential Tremor Rating Scale (TETRAS) scores, as well as accelerometric tremor analysis were done and follow-up assessments of the same were done after 12 weeks of intervention. Percentage change from baseline in the UPDRS tremor score was the primary outcome whereas percentage change from baseline of total UPDRS score, UPDRS rigidity and bradykinesia scores, TETRAS score, and accelerometric tremor analysis values were the secondary outcomes. RESULTS There was no significant difference in the percentage change from baseline UPDRS tremor scores between the two groups (placebo: 8.33 [-19.89-23.86] vs drug: 26.14 [-35.58 to -16.07], p-value: 0.164, CI: 0.157-0.171). Best-case analysis for missing values showed a significant improvement in the drug group, compared to the placebo group (p-value: < 0.001, CI: <0.001 - <0.001). CONCLUSION Zonisamide at a dose of 25 mg per day did not improve tremor in tremor-dominant PD patients, however, a positive trend was seen as compared to Placebo in the UPDRS tremor score. Larger studies are required to confirm this finding.
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Affiliation(s)
| | - Priyanka Bhat
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
| | | | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
| | | | | | - Mv Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
| | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
| | - V Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
| | - Awadh Kishor Pandit
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
| | - Vinay Goyal
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India; Institute of Neurosciences, Medanta the Medicity, Gurugram, Haryana, India.
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Bajaj K, Vora D, Parab P, Shaikh H, Gulia S, Rath S, Bajpai J, Shet T, Desai S, Popat P, Rajan R, Nair N, Joshi S, Pathak R, Sarin R, Kembhavi Y, Rane S, Ghosh J, Badwe R, Gupta S. 23P Combination chemotherapy and hormone therapy (CHT) in patients with hormone receptor (HR) positive, HER2 negative metastatic breast cancer (MBC): A single-centre retrospective analysis. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.032] [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: 12/05/2022] Open
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Shakywar M, Agarwal A, Padma Srivastava MV, Bhatia R, Singh MB, Rajan R, Gupta A, Pandit AK, Garg A, Sharma J, Gupta A, Upadhyay A, Vishnu VY. Predictors of Seizures and Associated Functional Outcome in a Cerebral Venous Thrombosis Cohort: An Ambispective Cohort Study. Ann Indian Acad Neurol 2022; 25:1056-1061. [PMID: 36911479 PMCID: PMC9996509 DOI: 10.4103/aian.aian_281_22] [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] [Received: 03/25/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/04/2022] Open
Abstract
Background and Purpose We aimed to explore the characteristics, clinical features, predictors of seizure, and associated clinical outcomes in patients with cerebral venous thrombosis (CVT). Methods We enrolled patients with CVT from January 2014 to July 2020. Prospectively patients were recruited from December 2018. We analyzed predictors of seizures and associated good functional outcomes (modified Rankin Scale, mRS: 0-2) using multivariable logistic regression. Results We enrolled 153 patients with CVT in which 77 (50%) had presented with a seizure. The median age was 31 years (IQR 16-46), and the majority were men (73.2%). Focal to bilateral tonic-clonic was the most common seizure type (27%), followed by generalized seizures (22%). None of the patients had status epilepticus. Antiseizure medications (ASM) were used in 71% of patients at diagnosis, 42% having received them prophylactically. Supratentorial parenchymal involvement was seen in 72% of seizure patients compared to 38% in those without, and superior sagittal sinus was most commonly involved. Percentage of patients who achieved good clinical outcome (mRS 0-2) at 3 months did not vary significantly between both groups. The only predictor for seizures with CVT was the presence of a parenchymal lesion (OR-3.75, 95% CI 1.79-7.85), whereas seizure occurrence (OR- 12.55, 95% CI- 1.53-102.59) was associated with statistically significant risk for recurrent seizures, by multiple logistic regression analysis. Seizure occurrence was not associated with adverse functional outcomes. Conclusion Seizures at presentation occurred in 50% of patients with CVT which was associated with a parenchymal lesion in the brain. There was no association between seizure at presentation and clinical outcome.
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Affiliation(s)
- Maneesh Shakywar
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | - M. V. Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | - Mamta B. Singh
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | - Awadh K. Pandit
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | - Jyoti Sharma
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | - Aakash Gupta
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | - Ashish Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | - Venugopalan Y. Vishnu
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
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Garg K, Singh M, Samala R, Rajan R, Gulati S, Goyal V. Bilateral pallidotomy for acquired or heredodegenerative generalized dystonia in children. Neurosurg Focus 2022; 53:E12. [DOI: 10.3171/2022.7.focus22332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/18/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE
Dystonias are relatively rare disorders characterized by sustained or intermittent muscle contractions causing abnormal movements or postures. Generalized dystonia is a therapeutic challenge because medications are unable to control dystonia adequately in most patients. These patients may be candidates for surgical therapy. The commonly used surgical procedures in these patients are pallidotomy and deep brain stimulation. Limited studies are available on the role of pallidotomy in children with acquired/heredodegenerative generalized dystonia. The objective of this study was to describe the authors’ experience with bilateral pallidotomy in this group of patients.
METHODS
The authors retrospectively reviewed all pediatric patients (less than 18 years of age) with acquired/heredodegenerative generalized dystonia who underwent bilateral simultaneous pallidotomy at their center between January 2014 and January 2021. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores before and after surgery were recorded. Complications arising after the procedure were recorded as well.
RESULTS
Ten patients (8 male and 2 female) with a mean (range) age of 11.1 (5–17) years were included in this study. The mean duration between disease onset and surgical intervention was 3.9 years. Two patients presented in status dystonicus. The mean ± SD (range) preoperative BFMDRS score of the patients without status dystonicus (n = 8) was 80 ± 18.9 (59.5–108). The mean ± SD BFMDRS score at the time of discharge from the hospital after surgery was 58.8 ± 37.9. Three patients had more than 20% change in BFMDRS score at the time of discharge from the hospital. The mean improvement was 25.5% at the end of 1 year. Of 5 surviving patients in the non–status dystonicus group, 3 patients had more than 40% change in BFMDRS score while the other 2 patients developed recurrence at the last follow-up (4.5 years). Status dystonicus abated after bilateral pallidotomy in both patients. Permanent bulbar complications were seen in 2 patients.
CONCLUSIONS
Bilateral pallidotomy may result in clinically significant improvement in children with acquired/heredodegenerative generalized dystonia, although the benefits should be closely weighed against the risk of irreversible bulbar dysfunction. It is a viable option for children in resource-limited settings.
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Affiliation(s)
- Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
| | - Raghu Samala
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi; and
| | - Sheffali Gulati
- Division of Child Neurology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Goyal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi; and
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Mishra B, Agarwal A, Gupta A, Garg A, Vishnu VY, Rajan R, Singh MB, Bhatia R, P Srivastava MV. Intracranial Abscess Unmasking Pulmonary AVF Due to Clandestine Hepatopulmonary Syndrome. Neurol India 2022; 70:2223-2224. [PMID: 36352652 DOI: 10.4103/0028-3886.359185] [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] [Indexed: 11/07/2022]
Affiliation(s)
- Biswamohan Mishra
- 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
| | - Anu Gupta
- 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
| | - Venugopalan Y Vishnu
- 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
| | - 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
| | - M V P Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Schumacher-Schuh AF, Bieger A, Okunoye O, Mok KY, Lim SY, Bardien S, Ahmad-Annuar A, Santos-Lobato BL, Strelow MZ, Salama M, Rao SC, Zewde YZ, Dindayal S, Azar J, Prashanth LK, Rajan R, Noyce AJ, Okubadejo N, Rizig M, Lesage S, Mata IF. Underrepresented Populations in Parkinson's Genetics Research: Current Landscape and Future Directions. Mov Disord 2022; 37:1593-1604. [PMID: 35867623 PMCID: PMC10360137 DOI: 10.1002/mds.29126] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 01/25/2022] [Revised: 04/18/2022] [Accepted: 05/30/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Human genetics research lacks diversity; over 80% of genome-wide association studies have been conducted on individuals of European ancestry. In addition to limiting insights regarding disease mechanisms, disproportionate representation can create disparities preventing equitable implementation of personalized medicine. OBJECTIVE This systematic review provides an overview of research involving Parkinson's disease (PD) genetics in underrepresented populations (URP) and sets a baseline to measure the future impact of current efforts in those populations. METHODS We searched PubMed and EMBASE until October 2021 using search strings for "PD," "genetics," the main "URP," and and the countries in Latin America, Caribbean, Africa, Asia, and Oceania (excluding Australia and New Zealand). Inclusion criteria were original studies, written in English, reporting genetic results on PD from non-European populations. Two levels of independent reviewers identified and extracted information. RESULTS We observed imbalances in PD genetic studies among URPs. Asian participants from Greater China were described in the majority of the articles published (57%), but other populations were less well studied; for example, Blacks were represented in just 4.0% of the publications. Also, although idiopathic PD was more studied than monogenic forms of the disease, most studies analyzed a limited number of genetic variants. We identified just nine studies using a genome-wide approach published up to 2021, including URPs. CONCLUSION This review provides insight into the significant lack of population diversity in PD research highlighting the immediate need for better representation. The Global Parkinson's Genetics Program (GP2) and similar initiatives aim to impact research in URPs, and the early metrics presented here can be used to measure progress in the field of PD genetics in the future. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Artur Francisco Schumacher-Schuh
- Departamento de Farmacologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Andrei Bieger
- Graduate Program in Biological Sciences: Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Olaitan Okunoye
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, United Kingdom
| | - Kin Ying Mok
- Department of Neurodegenerative Disease and UK Dementia Research Institute, University College of London, London, United Kingdom.,Division of Life Sciences, Hong Kong University of Science and Technology, Hong Kong, China
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Soraya Bardien
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Azlina Ahmad-Annuar
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Matheus Zschornack Strelow
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mohamed Salama
- Institute of Global Health and Human Ecology, The American University in Cairo, Cairo, Egypt
| | - Shilpa C Rao
- Genomic Medicine Institute, Lerner Research Institute, Genomic Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Yared Zenebe Zewde
- Department of Neurology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Saiesha Dindayal
- Division of Neurology, Department of Neurosciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jihan Azar
- Institute of Global Health and Human Ecology, The American University in Cairo, Cairo, Egypt
| | | | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Alastair J Noyce
- Preventive Neurology Unit, Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Njideka Okubadejo
- Department of Medicine, College of Medicine, University of Lagos, Lagos State, Nigeria
| | - Mie Rizig
- Institute of Neurology, University College of London, London, United Kingdom
| | - Suzanne Lesage
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, CIC Neurosciences, Paris, France
| | - Ignacio Fernandez Mata
- Genomic Medicine Institute, Lerner Research Institute, Genomic Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Rajan R, Garg K, Srivastava AK, Singh M. Device-Assisted and Neuromodulatory Therapies for Parkinson's Disease: A Network Meta-Analysis. Mov Disord 2022; 37:1785-1797. [PMID: 35866929 DOI: 10.1002/mds.29160] [Citation(s) in RCA: 2] [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: 03/08/2022] [Revised: 05/28/2022] [Accepted: 06/28/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Device-assisted and neuromodulatory therapies are the standard of care for Parkinson's disease (PD) with disabling motor complications. We aimed to compare and rank the currently available advanced therapies for PD on patient relevant outcomes. METHODS We searched various databases for randomized controlled trials that studied subthalamic nucleus deep brain stimulation (STN-DBS), globus pallidus interna (GPi) DBS, pallidotomy, subthalamotomy, continuous subcutaneous apomorphine infusion (CSAI), or intrajejunal levodopa infusion (IJLI), in patients with PD and motor complications. Primary outcome was the quality of life (QOL) at 6 months. Secondary outcomes included Unified Parkinson's Disease Rating Scale III and II, ON time, OFF time, levodopa equivalent daily doses, and adverse events (AE). Data were pooled using a Bayesian network meta-analysis, summarized as mean difference (MD) with 95% credibility intervals (CrI) and visualized in forest plots/league tables. Surface under the cumulative ranking curve plots determined the ranking probability. RESULTS We identified 6745 citations and included 26 trials. STN-DBS (MD, -8.0; 95% CrI, -11, -5.8), GPi-DBS (MD, -7.1; 95% CrI, -11, -2.9), and IJLI (MD, -7.0; 95% CrI, -12, -1.8) led to better QOL than medical therapy alone, without significant differences among them. STN-DBS had the highest probability of being ranked the best treatment for QOL (79.6%), followed by IJLI (63.5%) and GPi-DBS (62.8%). CONCLUSIONS In advanced PD, STN-DBS alleviates more patient and clinician relevant outcomes, followed by GPi-DBS and IJLI. In resource limited settings, unilateral pallidotomy may improve motor symptoms and activities of daily living, although overall QOL may not be improved. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Roopa Rajan
- Departments of Neurology, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Achal K Srivastava
- Departments of Neurology, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, CN Centre, All India Institute of Medical Sciences, New Delhi, India
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Pandit AK, Tangri P, Misra S, Srivastava MVP, Bhatnagar S, Thakar A, Sikka K, Panda S, Vishnu VY, Singh RK, Das A, Radhakrishnan DM, Srivastava AK, Subramaniam R, Trikha A, Agarwal A, Rajan R, Upadhyay V, Parikipandla S, Singh A, Kairo A. Mucormycosis in COVID-19 Patients: A Case-Control Study. Microorganisms 2022; 10:microorganisms10061209. [PMID: 35744726 PMCID: PMC9229175 DOI: 10.3390/microorganisms10061209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 04/22/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background: During the second wave of COVID-19, India faced a rapid and sudden surge of not only COVID19-delta variant cases but also mucormycosis, making the infection even more fatal. We conducted a study to determine factors associated with the occurrence of mucormycosis in patients with COVID-19. (2) Methods: This case–control study comprised 121 patients; 61 cases (mucormycosis with COVID-19) and 60 controls. Patients were included from April 10, 2021 onwards. Follow-up was conducted after about 90 days and health status was recorded based on the modified Rankin Scale (mRS). (3) Results: Mucormycosis with COVID-19 cases had a median (IQR) age of 49 (43–59) years with 65.6% males and were older (95% CI 1.015–1.075; p = 0.002) than in the control group with median (IQR) 38 (29–55.5) years and 66.6% males. Baseline raised serum creatinine (OR = 4.963; 95% CI 1.456–16.911; p = 0.010) and D-dimer (OR = 1.000; 95% CI 1.000–1.001; p = 0.028) were independently associated with the occurrence of mucormycosis in COVID-19 patients. Additionally, diabetes mellitus (OR = 26.919; 95% CI 1.666–434.892; p = 0.020) was associated with poor outcomes and increased mortality in patients with mucormycosis with COVID-19 as per the multivariable analysis. A total of 30/61 mucormycosis patients had intracranial involvement. (4) Conclusions: The study observed elevated levels of baseline raised creatinine and D-dimer in mucormycosis pa-tients with COVID-19 as compared to the control group. However, future studies may be conducted to establish this cause–effect relationship.
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Affiliation(s)
- Awadh Kishor Pandit
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (P.T.); (S.M.); (M.V.P.S.); (V.Y.V.); (R.K.S.); (A.D.); (D.M.R.); (A.K.S.); (A.A.); (R.R.); (V.U.); (S.P.)
- Correspondence: ; Tel.: +91-11-26594049
| | - Poorvi Tangri
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (P.T.); (S.M.); (M.V.P.S.); (V.Y.V.); (R.K.S.); (A.D.); (D.M.R.); (A.K.S.); (A.A.); (R.R.); (V.U.); (S.P.)
| | - Shubham Misra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (P.T.); (S.M.); (M.V.P.S.); (V.Y.V.); (R.K.S.); (A.D.); (D.M.R.); (A.K.S.); (A.A.); (R.R.); (V.U.); (S.P.)
| | - Madakasira Vasantha Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (P.T.); (S.M.); (M.V.P.S.); (V.Y.V.); (R.K.S.); (A.D.); (D.M.R.); (A.K.S.); (A.A.); (R.R.); (V.U.); (S.P.)
| | - Sushma Bhatnagar
- Department of Onco-Anesthesia, Pain and Palliative Care, All India Institute of Medical Sciences, New Delhi 110029, India;
| | - Alok Thakar
- Department of Otolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi 110029, India; (A.T.); (K.S.); (S.P.); (A.S.); (A.K.)
| | - Kapil Sikka
- Department of Otolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi 110029, India; (A.T.); (K.S.); (S.P.); (A.S.); (A.K.)
| | - Smriti Panda
- Department of Otolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi 110029, India; (A.T.); (K.S.); (S.P.); (A.S.); (A.K.)
| | - Venugopalan Y. Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (P.T.); (S.M.); (M.V.P.S.); (V.Y.V.); (R.K.S.); (A.D.); (D.M.R.); (A.K.S.); (A.A.); (R.R.); (V.U.); (S.P.)
| | - Rajesh Kumar Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (P.T.); (S.M.); (M.V.P.S.); (V.Y.V.); (R.K.S.); (A.D.); (D.M.R.); (A.K.S.); (A.A.); (R.R.); (V.U.); (S.P.)
| | - Animesh Das
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (P.T.); (S.M.); (M.V.P.S.); (V.Y.V.); (R.K.S.); (A.D.); (D.M.R.); (A.K.S.); (A.A.); (R.R.); (V.U.); (S.P.)
| | - Divya M. Radhakrishnan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (P.T.); (S.M.); (M.V.P.S.); (V.Y.V.); (R.K.S.); (A.D.); (D.M.R.); (A.K.S.); (A.A.); (R.R.); (V.U.); (S.P.)
| | - Achal Kumar Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (P.T.); (S.M.); (M.V.P.S.); (V.Y.V.); (R.K.S.); (A.D.); (D.M.R.); (A.K.S.); (A.A.); (R.R.); (V.U.); (S.P.)
| | - Rajeshwari Subramaniam
- Department of Anesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi 110029, India; (R.S.); (A.T.)
| | - Anjan Trikha
- Department of Anesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi 110029, India; (R.S.); (A.T.)
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (P.T.); (S.M.); (M.V.P.S.); (V.Y.V.); (R.K.S.); (A.D.); (D.M.R.); (A.K.S.); (A.A.); (R.R.); (V.U.); (S.P.)
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (P.T.); (S.M.); (M.V.P.S.); (V.Y.V.); (R.K.S.); (A.D.); (D.M.R.); (A.K.S.); (A.A.); (R.R.); (V.U.); (S.P.)
| | - Vibhor Upadhyay
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (P.T.); (S.M.); (M.V.P.S.); (V.Y.V.); (R.K.S.); (A.D.); (D.M.R.); (A.K.S.); (A.A.); (R.R.); (V.U.); (S.P.)
| | - Sathish Parikipandla
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (P.T.); (S.M.); (M.V.P.S.); (V.Y.V.); (R.K.S.); (A.D.); (D.M.R.); (A.K.S.); (A.A.); (R.R.); (V.U.); (S.P.)
| | - Anup Singh
- Department of Otolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi 110029, India; (A.T.); (K.S.); (S.P.); (A.S.); (A.K.)
| | - Arvind Kairo
- Department of Otolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi 110029, India; (A.T.); (K.S.); (S.P.); (A.S.); (A.K.)
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Parihar J, Vibha D, Rajan R, Pandit AK, Srivastava AK, Prasad K. Vanishing White Matter Disease Presenting as Dementia and Infertility: A Case Report. Neurol Genet 2022; 8:e643. [PMID: 35655585 PMCID: PMC9157580 DOI: 10.1212/nxg.0000000000000643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/24/2021] [Indexed: 11/15/2022]
Abstract
Objectives Vanishing white matter (VWM), an inherited leukoencephalopathy affecting the brain and the spinal cord, is most often a childhood-onset progressive disorder, generally presenting with ataxia. The adult-onset VWM is relatively rare with slowly progressive cognitive dysfunction dominating the clinical presentation. We report a case of adult-onset VWM from the Indian subcontinent. Methods Exome sequencing. Results A 58-year-old woman with young-onset diabetes and hypertension presented with gradually progressive cognitive decline beginning at age 40 years. She had early and predominant executive dysfunction and emotional lability and late involvement of memory and navigation. In addition to cognitive dysfunction, the patient experienced bladder and bowel incontinence along with a spastic gait. She also had primary infertility and menopause at age 40 years. Two of the patient's sisters had primary infertility; one of them had urine and stool incontinence along with gait disturbance. An MRI examination of the brain showed diffuse, symmetrical T2/fluid-attenuated inversion recovery white matter hyperintensities. On genetic testing, the patient was found to be homozygous for c.687T>G variation in the EIF2B3 gene. Discussion Adult-onset VWM is rare. Infertility in an adult patient with progressive cognitive decline should raise a suspicion of VWM.
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Affiliation(s)
- Jasmine Parihar
- Department of Neurology (J.P., D.V., R.R., A.K.P., A.K.S.), All India Institute of Medical Sciences, New Delhi; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Deepti Vibha
- Department of Neurology (J.P., D.V., R.R., A.K.P., A.K.S.), All India Institute of Medical Sciences, New Delhi; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Roopa Rajan
- Department of Neurology (J.P., D.V., R.R., A.K.P., A.K.S.), All India Institute of Medical Sciences, New Delhi; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Awadh Kishor Pandit
- Department of Neurology (J.P., D.V., R.R., A.K.P., A.K.S.), All India Institute of Medical Sciences, New Delhi; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Achal Kumar Srivastava
- Department of Neurology (J.P., D.V., R.R., A.K.P., A.K.S.), All India Institute of Medical Sciences, New Delhi; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Kameshwar Prasad
- Department of Neurology (J.P., D.V., R.R., A.K.P., A.K.S.), All India Institute of Medical Sciences, New Delhi; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
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Bin Waleed K, Lakhani I, Gong M, Liu T, Roever L, Christien Li KH, Rajan R, Qasim Ibrahimi M, Xia Y, Tse G, Chang D, Lee S. Heart rate variability and meditation: a meta-analysis. Europace 2022. [DOI: 10.1093/europace/euac053.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Meditation can induce changes in autonomic balance, which can benefit cardiovascular health. The present meta-analysis evaluated changes in heart rate variability (HRV) in meditators.
Methods
PubMed and Embase were searched for primary prospective studies using the search terms ‘heart rate variability’ and ‘meditation’ until January 18th, 2019. The statistical significance of the difference between subgroups is evaluated by the standardized mean difference (SMD), 95% confidence interval (CI), and P-value. I2 value was used to assess the statistical heterogeneity between the included studies.
Results
Twenty-one studies involving 538 meditators (experienced= 209, beginners= 329) and 334 controls (mean age= 40.61, 35% male) were included. Regarding time-domain indices, no statistically significant differences were observed when assessing HRV between i) meditators versus controls (SMD= -0.17; 95% CI: [-0.50, 0.17]; p= 0.30; I2= 0%), ii) pre- versus post-meditation (SMD= -0.41; 95% CI: [-1.10, 0.28]; p= 0.25; I2= 80%) or iii) at baseline versus during meditation (SMD= -0.40; 95% CI: [-0.94, 0.14]; p= 0.14; I2= 72%). Pertaining to frequency-domain indices, analysis of low frequency (LF), normalized low frequency (LFnu) and high frequency (HF) between i) meditators versus controls, ii) at baseline versus post-meditation and iii) at baseline versus during meditation yet again did not show any variations. Seven studies assessed normalized high frequency (HFnu) at baseline versus during meditation collectively demonstrated a significantly higher HFnu during meditation in beginners with notable heterogeneity (SMD= 1.29; 95% CI: [0.09, 2.49]; p= 0.04; I2= 95). Moreover, LF/HF was evaluated by seven studies at baseline versus during meditation. Both meta-analysis (SMD= 0.76; 95% CI: [-0.17, 1.69]; p= 0.11; I2= 94%) as well as subset analysis of experienced meditators (SMD= -0.46; 95% CI: [-0.88, -0.03]; p= 0.03; I2= 0%) revealed a significantly lower LF/HF at baseline.
Conclusions
Short-term changes in HRV indices were observed during meditation, but there is limited evidence for significant long-term effects.
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Affiliation(s)
- K Bin Waleed
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration, London, United Kingdom of Great Britain & Northern Ireland
| | - I Lakhani
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration, London, United Kingdom of Great Britain & Northern Ireland
| | - M Gong
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration, London, United Kingdom of Great Britain & Northern Ireland
| | - T Liu
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration, London, United Kingdom of Great Britain & Northern Ireland
| | - L Roever
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration, London, United Kingdom of Great Britain & Northern Ireland
| | - KH Christien Li
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration, London, United Kingdom of Great Britain & Northern Ireland
| | - R Rajan
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration, London, United Kingdom of Great Britain & Northern Ireland
| | - M Qasim Ibrahimi
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration, London, United Kingdom of Great Britain & Northern Ireland
| | - Y Xia
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration, London, United Kingdom of Great Britain & Northern Ireland
| | - G Tse
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration, London, United Kingdom of Great Britain & Northern Ireland
| | - D Chang
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration, London, United Kingdom of Great Britain & Northern Ireland
| | - S Lee
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration, London, United Kingdom of Great Britain & Northern Ireland
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Reyaz A, Agarwal A, Padma Srivastava MV, Bhatia R, Sharif A, Rajan R, Gupta A, Singh MB, Vishnu VY. Impact of Tele-Neuromuscular Clinic on the Accessibility of Care for Patients with Inherited Neuromuscular Disorders during COVID-19 Pandemic in India. Ann Indian Acad Neurol 2022; 25:505-507. [PMID: 35936601 PMCID: PMC9350811 DOI: 10.4103/aian.aian_565_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/02/2021] [Accepted: 09/01/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Alisha Reyaz
- 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
| | | | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - A Sharif
- Department of Anatomy and Incharge Telemedicine Services, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Rajan
- 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
| | - M. B. Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Rajan R, Garg K, Saini A, Radhakrishnan DM, Carecchio M, Bk B, Singh M, Srivastava AK. GPi-DBS for KMT2B-Associated Dystonia: Systematic Review and Meta-Analysis. Mov Disord Clin Pract 2022; 9:31-37. [PMID: 35005062 DOI: 10.1002/mdc3.13374] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 06/19/2021] [Revised: 10/11/2021] [Accepted: 10/30/2021] [Indexed: 12/26/2022] Open
Abstract
Background Early evidence suggests good response to pallidal deep brain stimulation (DBS) in DYT-KMT2B. Objectives We aimed to conduct a systematic review and meta-analysis to assess outcomes and identify predictors of good outcome following GPi-DBS in DYT-KMT2B. Methods We searched MEDLINE, Cochrane and MDS-abstracts databases using the MeSH terms "KMT2B and DYT28". We included studies that reported objective outcomes following GPi-DBS in DYT-KMT2B. The BFMDRS-M (Burke-Fahn-Marsden Dystonia Rating Scale- Movement) total scores pre- and post-surgery were used to quantify outcomes. We calculated pooled effects using a random effects meta-analysis and used meta-regression to identify potential effect modifiers. Multiple linear regression using individual patient data was used to identify predictors of good outcome (>50% improvement from baseline on BFMDRS-M). Results Initial searches screened 132 abstracts of which 34 full-text articles were identified to be of potential interest. Ten studies reporting 42 individual patients, met the inclusion/exclusion criteria and were included in the final review. The mean age at onset was 6.4 ± 5.7 years and 40% were male. The median follow-up was 12 months (range: 1-264 months). GPi-DBS resulted in median BFMDRS-M improvement of 42.7% (range: -103.5% to 95.9%) postoperatively. Pooled proportion of patients experiencing clinical improvement >50% on BFMDRS-M was 41% (95% CI: 27%-57%). Male gender [β: 22.6, 95% CI: 8.0-37.3, P = 0.004), and higher pre-operative BFMDRS-M score [β: 0.62, 95% CI: 0.36-0.87, P < 0.001) were independently associated with better outcome. Conclusion KMT2B-associated dystonia responds effectively to pallidal stimulation. The outcome is better in males and those with more severe dystonia at baseline.
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Affiliation(s)
- Roopa Rajan
- Department of Neurology All India Institute of Medical Sciences (AIIMS) New Delhi India
| | - Kanwaljeet Garg
- Department of Neurosurgery All India Institute of Medical Sciences (AIIMS) New Delhi India
| | - Arti Saini
- Department of Neurology All India Institute of Medical Sciences (AIIMS) New Delhi India
| | - Divya M Radhakrishnan
- Department of Neurology All India Institute of Medical Sciences (AIIMS) New Delhi India
| | - Miryam Carecchio
- Movement Disorders Unit, Department of Neuroscience University of Padua Padua Italy
| | - Binukumar Bk
- CSIR-Institute of Genomics and Integrative Biology New Delhi India
| | - Manmohan Singh
- Department of Neurosurgery All India Institute of Medical Sciences (AIIMS) New Delhi India
| | - Achal K Srivastava
- Department of Neurology All India Institute of Medical Sciences (AIIMS) New Delhi India
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Srivastava A, Dabla S, Garg D, Aggarwal R, Kumar N, Faruq M, Rajan R, Shukla G, Goyal V, Pandey R. Spinocerebellar ataxia 12 patients have better quality of life than spinocerebellar ataxia 1 and 2. Ann Indian Acad Neurol 2022; 25:647-653. [PMID: 36211176 PMCID: PMC9540941 DOI: 10.4103/aian.aian_611_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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/02/2021] [Accepted: 12/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Spinocerebellar ataxia is a neurodegenerative disease. Information on comparative assessment of quality of life (QoL) among SCAs, particularly SCA 12, is scarce. We aimed to compare health-related QoL in SCA 1, 2 and 12. Methods: We conducted a cross-sectional study among individuals with genetically-confirmed SCAs. Ataxia severity was assessed using Brief Ataxia Rating Scale (BARS), independence in activities of daily living (ADL) using Katz index (Katz ADL) and depression using Beck's Depression Inventory-II (BDI-II). QoL was assessed via Short Form Health Survey version 2.0 (SF-36). Results: We enrolled 89 individuals (SCA1 = 17, SCA2 = 43, SCA12 = 29; 56% males). Mean age at onset (41.0 ± 11.6 for SCA12 versus 24.9 + 7.0 for SCA1 and 28.8 ± 9.8 years for SCA2) was significantly higher among SCA12. SCA12 had lower BARS (mean score 4.1 ± 4.5 versus 10.6 ± 4.6 for SCA1 and 12.5 ± 4.5 for SCA2). SCA12 scored better on all SF-36 subdomains including Physical (PCS) and Mental Component Summary (MCS) scores. PCS score amongst SCA12 was 44.4 ± 9.0 versus 30.4 ± 9.1 for SCA1 and 33.3 ± 8.9 for SCA2. MCS score for SCA12 was 51.4 ± 11.4 versus 41.8 ± 11.5 for SCA1 and 41.8 ± 11.2 for SCA2. SCA12 had lower mean BDI scores (5.0 ± 6.0) versus SCA1 (9.5 ± 11.6) and SCA2 (10.9 ± 10.3). BARS and BDI emerged as significant predictors of most SF-36 subdomains. Conclusions: Our study suggests that despite older age and comparable disease duration, SCA12 patients experience better QoL, less severe depression and ataxia versus SCA1 and SCA2. Severity of ataxia and depression are significant predictors of QoL among the three SCA types.
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Bhatia R, Haldar P, Puri I, Padma Srivastava MV, Bhoi S, Jha M, Dey A, Naik S, Guru S, Singh M, Vishnu VY, Rajan R, Gupta A, Vibha D, Pandit A, Agarwal A, Salunkhe M, Singh G, Prasad D, Panda S, Anand S, Rohila A, Khera P, Tiwari S, Bhaskar S, Garg M, Kumar N, Dhar M, Tiwari A, Agrawal N, Raju G, Garg J, Ray B, Bhardwaj A, Verma A, Dongre N, Chhina G, Sibia R, Kaur R, Zanzmera P, Gamit A, Iype T, Garg R, Singh S, Kumar A, Ranjan A, Sardana V, Soni D, Bhushan B, Dhamija R, Saluja A, Bala K, Dabla S, Goswami D, Agarwal A, Shah S, Shah S, Patel M, Joshi P, Awasthi S, Nath S, Chandan S, Malik R, Chowdhury N. Study protocol: IMPETUS: Implementing a uniform stroke care pathway in medical colleges of India: IMPETUS Stroke. Ann Indian Acad Neurol 2022; 25:640-646. [PMID: 36211192 PMCID: PMC9540919 DOI: 10.4103/aian.aian_1033_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: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction: In India, a national program for stroke (national programme for the control of cardiovascular diseases, diabetes, cancer, and stroke) and stroke management guidelines exist. Its successful implementation would need an organized system of stroke care in practice. However, many challenges exist including lack of awareness, prehospital notification systems, stroke ready hospitals, infrastructural weaknesses, and rehabilitation. We present here a protocol to investigate the feasibility and fidelity of implementing a uniform stroke care pathway in medical colleges of India. Methods and Analysis: This is a multicentric, prospective, multiphase, mixed-method, quasi-experimental implementation study intended to examine the changes in a select set of stroke care-related indicators over time within the sites exposed to the same implementation strategy. We shall conduct process evaluation of the implementation process as well as evaluate the effect of the implementation strategy using the interrupted time series design. During implementation phase, education and training about standard stroke care pathway will be provided to all stakeholders of implementing sites. Patient-level outcomes in the form of modified Rankin Scale score will be collected for all consecutive patients throughout the study. Process evaluation outcomes will be collected and reported in the form of various stroke care indicators. We will report level and trend changes in various indicators during the three study phases. Discussion: Acute stroke requires timely detection, management, and secondary prevention. Implementation of the uniform stroke care pathway is a unique opportunity to promote the requirements of homogenous stroke care in medical colleges of India.
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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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Sharma M, Mahajan S, Dhall A, Jassal B, Saluja A, Faruq M, Suri V, Rajan R, Vishnu V. Anoctamin-5 Muscular Dystrophy: Report of Two Cases with Different Phenotypes and Genotypes from the Indian Subcontinent. Neurol India 2022; 70:2169-2173. [DOI: 10.4103/0028-3886.359155] [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: 11/06/2022]
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Gupta A, Agarwal A, Gupta P, Sharma A, Garg A, Rajan R, Vishnu V, Bhatia R, Singh M, Goyal V, Padma Srivastava MV. Myelin oligodendrocyte glycoprotein antibody syndrome and seizures: A diagnostic clue. Ann Indian Acad Neurol 2022; 25:163-167. [PMID: 35342260 PMCID: PMC8954327 DOI: 10.4103/aian.aian_131_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/21/2021] [Accepted: 05/03/2021] [Indexed: 11/08/2022] Open
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Sharma A, Agarwal A, Srivastava P, Garg A, Rajan R, Gupta A, Bhatia R, Singh MB, Sharma MC, Vishnu V. Hypertension with recurrent focal deficits. Pract Neurol 2021; 21:555-558. [PMID: 34059557 DOI: 10.1136/practneurol-2021-003020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/04/2022]
Affiliation(s)
| | | | | | - Ajay Garg
- Neuroradiology, AIIMS, New Delhi, India
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Agarwal A, Salunkhe M, Gupta A, Vishnu VY, Garg A, Rajan R, Srivastava MVP. An Acquired Neuro-Nephrology Syndrome. J Clin Rheumatol 2021; 27:S647-S648. [PMID: 33323751 DOI: 10.1097/rhu.0000000000001663] [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: 11/26/2022]
Affiliation(s)
| | | | | | | | - Ajay Garg
- Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
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Agarwal A, Sharma J, Padma Srivastava MV, Bhatia R, Singh MB, Gupta A, Pandit AK, Singh R, Rajan R, Dwivedi S, Upadhyay A, Garg A, Vishnu VY. Early Post-Stroke Seizures in Acute Ischemic Stroke: A Prospective Cohort Study. Ann Indian Acad Neurol 2021; 24:580-585. [PMID: 34728954 PMCID: PMC8513968 DOI: 10.4103/aian.aian_1283_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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/31/2021] [Accepted: 03/01/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Stroke is the most common cause of epilepsy in the adult population. Post-stroke seizures (PSSs) are classified into early-onset seizures (ES) and late-onset (LS). ES can significantly affect the clinical outcome and occurrence of LS. Methods We analyzed data from a prospective cohort of acute ischemic stroke patients between June 2018 and May 2020 in a neurology unit at a tertiary hospital. We screened all acute stroke patients and included consecutive patients older than 18 years of age, presenting with acute, first-ever neuroimaging-confirmed ischemic stroke. We excluded patients with a previous stroke, transient ischemic attacks, hemorrhagic stroke, cerebral venous thrombosis, prior history of seizures, or any other epileptogenic comorbidity. ES were classified as spontaneous seizures occurring within 1 week of the stroke. The main outcome assessed was the occurrence of ES. The secondary outcome was to determine predictors of ES and create an ES prediction score. Results We screened 432 patients; of them, 291 were enrolled. ES occurred in 37 patients (12.7%). Cortical location (OR: 4.2), large artery disease subtype (OR: 2.9), mRS at presentation (OR: 1.4), use of anticoagulants (OR: 2.6), and hypertension (OR: 0.3) were significantly associated with the occurrence of ES. Patients with ES had a statistically significant worse clinical outcome at 3 months follow-up (P = 0.0072). Conclusion We could formulate an ES prediction tool using the following components: (a) cortical location, (b) large vessel stroke, (c) mRS at admission, (d) anticoagulant use, and (e) presence of hypertension. This tool might help in treating patients at high risk for ES with prophylactic ASD, thereby preventing seizures and their complications.
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Affiliation(s)
- Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoti Sharma
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma 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
| | - Anu Gupta
- 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
| | - Rajesh Singh
- 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
| | - Sadanand Dwivedi
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Anand M, Vishnu V, Srivastava MP, Bhatia R, Singh M, Rajan R, Gupta A, Singh R. An ambispective cohort study of chronic inflammatory demyelinating neuropathy, and its variants. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118819] [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: 11/24/2022]
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Komakula S, Bhatia R, Srivastava MP, Tripathi M, Vibha D, Singh M, Garg A, Joseph L, Singh R, Rajan R, Gupta A, Pandit A, Vishnu V. Safety and efficacy of N acetylcysteine as an adjunct to standard treatment in patients with acute ischemic stroke - a randomized controlled trial (NACTLYS). J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118760] [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: 11/25/2022]
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Srivastava AK, Narang M, Kumaran S, Rajan R, Faruq M, Srivastava MP. Dentato-rubro-thalamic tract (DRTT) dysfunction in the emergence of tremor in spinocerebellar ataxia type −12 (SCA-12). J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117866] [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: 11/26/2022]
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