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Alugolu R, Kolpakwar S, Mudumba V, Arora A, Kandadai R, Borgohain R. Prospective analysis of gross and fine electrode position and motor manifestations after STN-DBS and their correlation with electrode position. J Neurosurg Sci 2024; 68:201-207. [PMID: 34647713 DOI: 10.23736/s0390-5616.21.05461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) has been proven to be a safe, reversible, cost-effective procedure for treatment of Parkinson's disease. Final electrode position remains a significant factor determining the outcomes of subthalamic nucleus DBS (STN-DBS). This study aims to analyze the final lead position in three-dimensional plane and its effect on gross and fine motor outcomes in cases of advanced Parkinson's disease operated for STN-DBS. METHODS Patients who underwent bilateral STN-DBS were prospectively followed for improvement in gross motor outcomes at 6 months. Improvement in dysgraphia was analyzed by Fahn-Tolosa-Marin Tremor Rating Scale Part B Score. Postoperative outcomes were correlated with final electrode position. RESULTS A total of 64 Patients (128 leads) were analyzed. Patients who were less than 65 years of age at time of surgery had more significant reduction in UPDRS III (P=0.02). Cases with deviation of left x less than 3 mm had significant reduction in UPDRS III (P=0.05) and speech sub-scores (P=0.05). Deviation less than 2 mm in left x was associated with reduction in gait sub-scores (P=0.04). Optimal placement of right y electrode was associated with reduction in UPDRS III (P=0.02). Significant reduction in Fahn-Tolosa-Marin Tremor Rating Scale Part B Score was noted after DBS (P=0.001). CONCLUSIONS Subthalamic nucleus DBS thus results in significantly improved functional outcome particularly in patients with age less than 65 years. Accurate final electrode position is associated with maximum clinical benefit and improvement in dysgraphia.
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Affiliation(s)
- Rajesh Alugolu
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, India -
| | - Swapnil Kolpakwar
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, India
| | | | - Abhishek Arora
- Department of Radiology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Rukmini Kandadai
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Rupam Borgohain
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
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Andrews SV, Kukkle PL, Menon R, Geetha TS, Goyal V, Kandadai RM, Kumar H, Borgohain R, Mukherjee A, Wadia PM, Yadav R, Desai S, Kumar N, Joshi D, Murugan S, Biswas A, Pal PK, Oliver M, Nair S, Kayalvizhi A, Samson PL, Deshmukh M, Bassi A, Sandeep C, Mandloi N, Davis OB, Roberts MA, Leto DE, Henry AG, Di Paolo G, Muthane U, Das SK, Peterson AS, Sandmann T, Gupta R, Ramprasad VL. The Genetic Drivers of Juvenile, Young, and Early-Onset Parkinson's Disease in India. Mov Disord 2024; 39:339-349. [PMID: 38014556 DOI: 10.1002/mds.29676] [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: 07/13/2023] [Revised: 10/18/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Recent studies have advanced our understanding of the genetic drivers of Parkinson's disease (PD). Rare variants in more than 20 genes are considered causal for PD, and the latest PD genome-wide association study (GWAS) identified 90 independent risk loci. However, there remains a gap in our understanding of PD genetics outside of the European populations in which the vast majority of these studies were focused. OBJECTIVE The aim was to identify genetic risk factors for PD in a South Asian population. METHODS A total of 674 PD subjects predominantly with age of onset (AoO) ≤50 years (encompassing juvenile, young, or early-onset PD) were recruited from 10 specialty movement disorder centers across India over a 2-year period; 1376 control subjects were selected from the reference population GenomeAsia, Phase 2. We performed various case-only and case-control genetic analyses for PD diagnosis and AoO. RESULTS A genome-wide significant signal for PD diagnosis was identified in the SNCA region, strongly colocalizing with SNCA region signal from European PD GWAS. PD cases with pathogenic mutations in PD genes exhibited, on average, lower PD polygenic risk scores than PD cases lacking any PD gene mutations. Gene burden studies of rare, predicted deleterious variants identified BSN, encoding the presynaptic protein Bassoon that has been previously associated with neurodegenerative disease. CONCLUSIONS This study constitutes the largest genetic investigation of PD in a South Asian population to date. Future work should seek to expand sample numbers in this population to enable improved statistical power to detect PD genes in this understudied group. © 2023 Denali Therapeutics and The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Shan V Andrews
- Denali Therapeutics, South San Francisco, California, USA
| | - Prashanth L Kukkle
- Manipal Hospital, Bangalore, India
- Parkinson's Disease and Movement Disorders Clinic, Bangalore, India
| | | | | | - Vinay Goyal
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
- Medanta Hospital, New Delhi, India
- Medanta, The Medicity, Gurgaon, India
| | - Rukmini Mridula Kandadai
- Nizams Institute of Medical Sciences (NIMS), Hyderabad, India
- Citi Neuro Centre, Hyderabad, India
| | | | - Rupam Borgohain
- Nizams Institute of Medical Sciences (NIMS), Hyderabad, India
- Citi Neuro Centre, Hyderabad, India
| | - Adreesh Mukherjee
- Bangur Institute of Neurosciences and Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, India
| | | | - Ravi Yadav
- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Soaham Desai
- Department of Neurology, Shree Krishna Hospital and Pramukhaswami Medical College, Bhaikaka University, Anand, India
| | - Niraj Kumar
- All India Institute of Medical Sciences, Rishikesh, India
- All India Institute of Medical Sciences, Bibinagar (Hyderabad Metropolitan Region), Bibinagar, India
| | - Deepika Joshi
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | | | - Atanu Biswas
- Bangur Institute of Neurosciences and Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, India
| | - Pramod K Pal
- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | | | | | | | | | | | | | | | | | - Oliver B Davis
- Denali Therapeutics, South San Francisco, California, USA
| | | | - Dara E Leto
- Denali Therapeutics, South San Francisco, California, USA
| | | | | | - Uday Muthane
- Parkinson and Ageing Research Foundation, Bangalore, India
| | - Shymal K Das
- Bangur Institute of Neurosciences and Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, India
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Metta V, Ibrahim H, Muralidharan N, Rodriguez K, Masagnay T, Mohan J, Lacsina A, Ahmed A, Benamer HTS, Chung-Faye G, Mrudula R, Falup-Pecurariu C, Rodriguez-Blazquez C, Borgohain R, Goyal V, Bhattacharya K, Chaudhuri KR. A 12-month prospective real-life study of opicapone efficacy and tolerability in Emirati and non-White subjects with Parkinson's disease based in United Arab Emirates. J Neural Transm (Vienna) 2024; 131:25-30. [PMID: 37798410 PMCID: PMC10769978 DOI: 10.1007/s00702-023-02700-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/17/2023] [Indexed: 10/07/2023]
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disorder, and the condition is complicated by the emergence of wearing off/motor fluctuations with levodopa treatment after a variable period. COMT inhibitors when used as adjunct therapy to levodopa tend to smoothen out these wearing off fluctuations by enhancing delivery of levodopa and increasing its bioavailability to the brain. The study was conducted to investigate the motor and nonmotor effect, safety and tolerability of the third generation once-daily COMT inhibitor (opicapone), as add-on, adjuvant therapy to levodopa and at 6 and 12 months follow-up in a real-life cohort of consecutive Emirati and non-White PD patients. A real-life observational analysis using tolerability parameters as used previously by Rizos et al. and Shulman et al. based on clinical database of cases rat Kings College Hospital Dubai Parkinson care database. This was a prospective, single-arm follow-up clinical evaluation study that evaluated the effectiveness of opicapone 50 mg once-daily regime in 50 patients diagnosed with idiopathic neurodegenerative disorder. All patients were assessed with scales used in clinical pathway and include motor Unified Parkinson's Disease Rating Scale (UPDRS), nonmotor symptom scale (NMSS), quality of life (PDQ8) Parkinson's fatigue scale (PFS16) and King's Parkinson's Pain Scale (KIPS). Out of 50 patients treated with opicapone (72% male, mean age 66.9 years (SD 9.9, range 41-82 years) and mean duration of disease 5.7 years (SD 2.5 range (2-11), there was significant statistical improvements shown in motor function-UPDRS part 3: baseline 40.64 ± 2.7, at 6 months 32.12 ± 3.14 and after 12 months 33.72 ± 3.76. Nonmotor burden NMSS: 107.00 ± 21.86, at 6 months 100.78 ± 17.28 and 12 months 96.88 ± 16.11. Reduction in dyskinesias (UPDRS part 4): baseline 8.78 ± 1.07, at 6 months 7.4 ± 0.81 and 12 months 6.82 ± 0.75. Opicapone provides beneficial motor and nonmotor effects in Emirati and other non-White Parkinson's patients, resident in UAE, proving its efficacy across different racial groups as COMT activity may vary between races.
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Affiliation(s)
- Vinod Metta
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK.
- Parkinson's Foundation Centre of Excellence, King's College Hospital, Dubai, United Arab Emirates.
| | - Huzaifa Ibrahim
- Parkinson's Association United Arab Emirates, Dubai, United Arab Emirates
| | - Neha Muralidharan
- Parkinson's Foundation Centre of Excellence, King's College Hospital, Dubai, United Arab Emirates
| | - Kislyn Rodriguez
- Parkinson's Foundation Centre of Excellence, King's College Hospital, Dubai, United Arab Emirates
| | - Therese Masagnay
- Parkinson's Foundation Centre of Excellence, King's College Hospital, Dubai, United Arab Emirates
| | - Judith Mohan
- Parkinson's Foundation Centre of Excellence, King's College Hospital, Dubai, United Arab Emirates
| | - Arlet Lacsina
- Parkinson's Foundation Centre of Excellence, King's College Hospital, Dubai, United Arab Emirates
| | - Abdullah Ahmed
- Parkinson's Foundation Centre of Excellence, King's College Hospital, Dubai, United Arab Emirates
| | - Hani T S Benamer
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Guy Chung-Faye
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, Dubai, United Arab Emirates
| | - Rukmini Mrudula
- Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | | | - Rupam Borgohain
- Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Vinay Goyal
- Institute of Movement Disorders and Parkinson's Centre, Medanta Hospitals, Delhi, India
| | | | - K Ray Chaudhuri
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, Dubai, United Arab Emirates
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Yaranagula SD, Kashyap M, Kola S, Kandadai RM, Alugolu R, Prasad V, Jasani GA, Borgohain R, Varma RD. Delayed Peri-Lead Intracerebral Hemorrhage Months after Deep Brain Stimulation: A Series of Two Patients. Ann Indian Acad Neurol 2024; 27:96-98. [PMID: 38495230 PMCID: PMC10941881 DOI: 10.4103/aian.aian_846_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: 09/22/2023] [Revised: 10/06/2023] [Accepted: 10/22/2023] [Indexed: 03/19/2024] Open
Affiliation(s)
- Sai Deepak Yaranagula
- Department of Neurology, Parkinson's Disease and Movement Disorder Research Centre, Banjara Hills, Hyderabad, Telangana, India
| | - Manshi Kashyap
- Department of Neurology, Parkinson's Disease and Movement Disorder Research Centre, Banjara Hills, Hyderabad, Telangana, India
| | - Sruthi Kola
- Department of Neurology, Parkinson's Disease and Movement Disorder Research Centre, Banjara Hills, Hyderabad, Telangana, India
| | - Rukmini Mridula Kandadai
- Department of Neurology, Parkinson's Disease and Movement Disorder Research Centre, Banjara Hills, Hyderabad, Telangana, India
| | - Rajesh Alugolu
- Department of Neurology, Parkinson's Disease and Movement Disorder Research Centre, Banjara Hills, Hyderabad, Telangana, India
| | - Vanakuru Prasad
- Department of Neurology, Parkinson's Disease and Movement Disorder Research Centre, Banjara Hills, Hyderabad, Telangana, India
| | | | - Rupam Borgohain
- Department of Neurology, Parkinson's Disease and Movement Disorder Research Centre, Banjara Hills, Hyderabad, Telangana, India
| | - Ravi Dandu Varma
- Department of Neuroradiology, Citi Neuro Centre, Banjara Hills, Hyderabad, Telangana, India
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Kandadai RM, Yaranagula SD, Kola S, Alugolu R, Prasad V, Borgohain R. Complex Movement Disorder with Prominent Tic like Movements: Expanding the Clinical Spectrum of IgLON 5 Antibody Disease. Mov Disord Clin Pract 2024; 11:94-96. [PMID: 38291846 PMCID: PMC10828616 DOI: 10.1002/mdc3.13929] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/11/2023] [Accepted: 11/07/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
| | - Sai Deepak Yaranagula
- Parkinson's Disease and Movement Disorder Research Centre, Citi Neuro CentreHyderabadIndia
| | - Sruthi Kola
- Parkinson's Disease and Movement Disorder Research Centre, Citi Neuro CentreHyderabadIndia
| | - Rajesh Alugolu
- Parkinson's Disease and Movement Disorder Research Centre, Citi Neuro CentreHyderabadIndia
| | - Vanakuru Prasad
- Parkinson's Disease and Movement Disorder Research Centre, Citi Neuro CentreHyderabadIndia
| | - Rupam Borgohain
- Parkinson's Disease and Movement Disorder Research Centre, Citi Neuro CentreHyderabadIndia
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Yaranagula SD, Mathukumalli NL, Kola S, Kandadai RM, Prasad V, Alugolu R, Borgohain R. Aceruloplasminemia with Novel Mutation, with IgG4 Related Pachymeningitis - Occam's Razor or Hickam's Dictum? Ann Indian Acad Neurol 2023; 26:994-996. [PMID: 38229630 PMCID: PMC10789395 DOI: 10.4103/aian.aian_455_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: 05/23/2023] [Revised: 06/17/2023] [Accepted: 06/25/2023] [Indexed: 01/18/2024] Open
Abstract
To report a patient with concomitant aceruloplasminemia (with a novel mutation) and IgG4-related pachymeningitis and to hypothesize on the possible relation between the two diseases. Clinical, radiological, and laboratory features of a 56-year-old lady with chronic headache, bifacial palsy, and cerebellar signs are described. Pathophysiology of aceruloplasminemia leading to hyperferritinemia and consequent immune activation is elucidated. A coherent explanation of IgG4-related pachymeningitis resulting from aceruloplasminemia and hyperferritinemia is given. The patient has aceruloplasminemia with a novel nonsense mutation. She also suffers from biopsy-proven IgG4 related pachymeningitis as per standard criteria. These two seemingly unrelated illnesses are linked by hyperferritinemia. This case is a fine example of Occam's razor. Immune dysfunction and autoimmune disorders in aceruloplasminemia need to be explored through further studies to look for causal associations.
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Affiliation(s)
- Sai D. Yaranagula
- Parkinson's Disease and Movement Disorders Research Centre (PDMDRC), Citi Neuro Centre, Hyderabad, Telangana, India
| | | | - Sruthi Kola
- Parkinson's Disease and Movement Disorders Research Centre (PDMDRC), Citi Neuro Centre, Hyderabad, Telangana, India
- Department of Neurology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rukmini M. Kandadai
- Parkinson's Disease and Movement Disorders Research Centre (PDMDRC), Citi Neuro Centre, Hyderabad, Telangana, India
- Department of Neurology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Vanakuru Prasad
- Parkinson's Disease and Movement Disorders Research Centre (PDMDRC), Citi Neuro Centre, Hyderabad, Telangana, India
- Department of Neurology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rajesh Alugolu
- Parkinson's Disease and Movement Disorders Research Centre (PDMDRC), Citi Neuro Centre, Hyderabad, Telangana, India
| | - Rupam Borgohain
- Parkinson's Disease and Movement Disorders Research Centre (PDMDRC), Citi Neuro Centre, Hyderabad, Telangana, India
- Department of Neurology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
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Metta V, Dhamija RK, Batzu L, Mrudula R, Kumar NSS, S A, Falup-Pecurariu C, Rodriguez-Blazquez C, Goyal V, L K P, Bhattacharya K, Kumar S, Chaudhuri KR, Borgohain R. Safety and tolerability of long-term apomorphine infusion in advanced Parkinson's disease: an Indian multi-center (APO-IND) experience. Sci Rep 2023; 13:18681. [PMID: 37907679 PMCID: PMC10618227 DOI: 10.1038/s41598-023-46003-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/26/2023] [Indexed: 11/02/2023] Open
Abstract
Advanced Parkinson's Disease (APD) is complicated by the emergence of motor and non-motor fluctuations, which are initially predictable and eventually become unpredictable, in part due to erratic gastric absorption and short half of oral levodopa. Attempts to manage such fluctuations with oral dopaminergic drugs often lead to disabling dyskinesias. Continuous Subcutaneous Apomorphine Infusion (CSAI), despite being approved for the treatment of APD since 1993, was approved in India only in 2019. We studied the safety, tolerability and efficacy of CSAI in Indian patients with APD in a registry design to raise local awareness of this important treatment. We conducted a prospective registry-based observational audit at 10 centers across different states of India. Patients with APD, not responding to or with significant side effects from oral dopaminergic therapy, were assessed at baseline and at month 6 and 12 following CSAI infusion. Fifty-one patients completed the study, CSAI significantly reduced the functional impact of dyskinesia (p < 0.01 at 6 months and p < 0.001 at 12 months). There was a significant improvement in the OFF-state from baseline (p < 0.01 at 6 months and p < 0.001 at 12 months) No discernible side effects were observed apart from mild site reaction (n = 7), nausea (n = 7) skin nodules (n = 2). CSAI demonstrated safety, efficacy, tolerability and improved quality of life in patients with APD, as shown in previous studies. Our study highlighted current existing inequalities in treatment availability, lack of awareness, knowledge gap, affordability and cost remains a concern regarding apomorphine use in Indian PD population.
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Affiliation(s)
- Vinod Metta
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience and Parkinson's Foundation Centre of Excellence, King's College London, King's College Hospital, London, UK.
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, Dubai, United Arab Emirates.
- Parkinson's Foundation Centre of Excellence, King's College Hospital London, London, SE5 9RS, UK.
| | - Rajinder K Dhamija
- Institute of Human Behavior and Allied Sciences, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
| | - Lucia Batzu
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience and Parkinson's Foundation Centre of Excellence, King's College London, King's College Hospital, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, Dubai, United Arab Emirates
| | - Rukmini Mrudula
- Institute of Movement Disorders, Narayana Medical College and Postgraduate Research Centre, Nellore, India
- Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Natuva Sai Sampath Kumar
- Institute of Movement Disorders, Narayana Medical College and Postgraduate Research Centre, Nellore, India
| | - Arunan S
- SRM Institute of Medical Sciences and Technology, Chennai, India
| | | | | | - Vinay Goyal
- Institute of Movement Disorders and Parkinson's Centre, Medanta Hospital, New Delhi, India
| | - Prashanth L K
- Center for Parkinson's Disease and Movement Disorders, Manipal Hospital, Bangalore, India
| | | | - Suresh Kumar
- Amrita Institute of Medical Sciences, Kochi, India
| | - Kallol Ray Chaudhuri
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience and Parkinson's Foundation Centre of Excellence, King's College London, King's College Hospital, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, Dubai, United Arab Emirates
| | - Rupam Borgohain
- Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
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Srivastava MK, Shaik AJ, Yareeda S, Nallapareddy K, Lingappa L, Moturi P, Gaddamonugu P, Kandadai RM, Borgohain R. Neurocognitive Profile and 18 F-Fluorodeoxyglucose Positron Emission Tomography Brain Imaging Correlation in Children with Electrical Status Epilepticus during Sleep. World J Nucl Med 2023; 22:174-182. [PMID: 37854089 PMCID: PMC10581755 DOI: 10.1055/s-0042-1757284] [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] [Indexed: 10/20/2023] Open
Abstract
Objective Electrical status epilepticus in sleep (ESES) is defined by near-continuous epileptiform discharges during sleep along with cognitive, behavioral, and/or imaging abnormalities. We studied the neurocognitive profile and their correlation with 18 F fluorodeoxyglucose positron emission tomography (FDG PET) brain abnormalities in children with ESES. Methods Fourteen children with ESES with normal magnetic resonance imaging (MRI) from March to December 2019 were included. The intelligence quotient (IQ) and child behavior checklist (CBCL) scores were estimated using validated scales, and FDG PET brain was done at the same point of time to look for cerebral metabolic defects which was compared with a control group. Results Fourteen patients with a mean age of 8.2 ± 2.7 years were analyzed. The average duration of epilepsy was 6 ± 2.8 years. The mean IQ was 72.4 ± 18.2 and mean CBCL score was 37.3 ± 11.8. There was negative correlation between IQ and CBCL ( r = -0.55, p < 0.001). The duration of epilepsy also showed negative correlation with IQ ( r = -4.75, p < 0.001). FDG PET scan showed predominant thalamic hypometabolism in 12 of 14 patients (85.7%) on visual analysis with multiple other hypometabolic cortical and subcortical regions in the brain. The quantitative analysis showed significant difference in metabolism of basal ganglion when compared with control group. The total number of hypometabolic regions seen in the brain showed moderate positive correlation with CBCL score but no significant correlation with the IQ of cases. Conclusion This study demonstrates functional impairment of cerebral cortical, basal ganglia, and thalamic hypometabolism in a cohort of ESES patients with normal structural MRI brain study. There was a moderate correlation of extent and pattern of cerebral hypometabolism with the neuropsychological status of the child and duration of epilepsy.
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Affiliation(s)
- Madhur K. Srivastava
- Department of Nuclear Medicine, Nizam's Institute of Medical Sciences (NIMS), Panjagutta, Hyderabad, Telangana, India
| | - Afshan J. Shaik
- Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Panjagutta, Hyderabad, Telangana, India
| | - Sireesha Yareeda
- Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Panjagutta, Hyderabad, Telangana, India
| | - Kavitha Nallapareddy
- Department of Nuclear Medicine, Nizam's Institute of Medical Sciences (NIMS), Panjagutta, Hyderabad, Telangana, India
| | - Lokesh Lingappa
- Department of Pediatric Neurology, Rainbow Children Hospital, Banjara Hills, Hyderabad, Telangana, India
| | - Pallavi Moturi
- Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Panjagutta, Hyderabad, Telangana, India
| | - Padmaja Gaddamonugu
- Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Panjagutta, Hyderabad, Telangana, India
| | - Rukmini M. Kandadai
- Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Panjagutta, Hyderabad, Telangana, India
| | - Rupam Borgohain
- Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Panjagutta, Hyderabad, Telangana, India
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Kola S, Kandadai RM, Kashyap M, Deepak S, Prasad VVSRK, Alugolu R, Borgohain R. Dystonia Deafness Syndrome: A Rare Deep Brain Stimulation Responsive Dystonia. Ann Indian Acad Neurol 2023; 26:766-768. [PMID: 38022471 PMCID: PMC10666884 DOI: 10.4103/aian.aian_319_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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 12/01/2023] Open
Abstract
Dystonia deafness syndrome (DDS) is a rare syndrome characterized by childhood onset sensorineural deafness followed by adult-onset dystonia. We here report the first case of DDS from India caused by ACTB gene mutation presented with deafness, generalized dystonia and scoliosis who showed improvement after Deep brain stimulation.
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Affiliation(s)
- Sruthi Kola
- Department of Parkinson's Disease and Movement Disorders Research Centre (PDMDRC), Citi Neuro Centre, Telangana, India
| | - Rukmini Mridula Kandadai
- Department of Parkinson's Disease and Movement Disorders Research Centre (PDMDRC), Citi Neuro Centre, Telangana, India
| | - Mansi Kashyap
- Department of Parkinson's Disease and Movement Disorders Research Centre (PDMDRC), Citi Neuro Centre, Telangana, India
| | - Sai Deepak
- Department of Parkinson's Disease and Movement Disorders Research Centre (PDMDRC), Citi Neuro Centre, Telangana, India
| | - VVSRK Prasad
- Department of Parkinson's Disease and Movement Disorders Research Centre (PDMDRC), Citi Neuro Centre, Telangana, India
| | - Rajesh Alugolu
- Department of Parkinson's Disease and Movement Disorders Research Centre (PDMDRC), Citi Neuro Centre, Telangana, India
| | - Rupam Borgohain
- Department of Parkinson's Disease and Movement Disorders Research Centre (PDMDRC), Citi Neuro Centre, Telangana, India
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Kola S, Rangam RP, Kandadai RM, Alugolu R, Kedasi R, Swamygowda P, Prasad VVSRK, Meka SSL, Fathima ST, Borgohain R. Changes in Optimal Stimulation Frequency with Time for Gait Disturbances in Patients with PD after STN-DBS-A Longitudinal Study. Ann Indian Acad Neurol 2023; 26:401-407. [PMID: 37970314 PMCID: PMC10645258 DOI: 10.4103/aian.aian_95_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: 03/28/2023] [Accepted: 05/03/2023] [Indexed: 11/17/2023] Open
Abstract
Aim To assess the changes in frequency parameters of STN-DBS stimulation over 6 months required to optimize gait in PD patients. Methods It's a single center, open label longitudinal study of PD patients after STN-DBS with gait disorders. Gait assessment using stand-walk-sit (SWS) test and freezing of gait (FOG) scores were done at baseline and after 6 months. Gait was assessed in five frequencies settings, that is, 60 Hz, 90 Hz, 130 Hz, 180 Hz and stimulation "OFF" during medication ON state. Voltage was maintained. Results Fifteen post-deep brain stimulation (DBS) patients were included. Mean duration after surgery was 3.73 ± 2.82 years. In SWS and FOG at baseline, five patients have good response at 180 Hz frequency, five at 130 Hz, one at 90 Hz, two patients at 60 Hz, one both 60 and 90 Hz, and one at both 90 and 180 HZ. And after 6 months out of the 13 patients who were able to perform the test, four patients had good response at 180 Hz frequency, four at 130 Hz, two at 90 Hz, one each for 60 Hz and battery OFF state, and one for both 130 Hz and 180 Hz. At 6 months, four patients had good response at the same frequency as baseline, while 11 patients have change in frequency from baseline. Conclusion Optimal frequency for gait varies in patients-both low and high frequency may be useful. Optimal frequency for improving gait changes over period of time. Regular assessment and changing frequency may improve gait after DBS.
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Affiliation(s)
- Sruthi Kola
- Department of Neurology, Government Medical College, Ananthapuram, Andhra Pradesh, India
| | - Ravi Prakash Rangam
- Department of Neurology, Government Medical College, Ananthapuram, Andhra Pradesh, India
| | | | - Rajesh Alugolu
- Department of Neurosurgery, Citi Neuro Centre, Telangana, India
| | - Raghuram Kedasi
- Department of Neurosurgery, Nizam’s Institute of Medical Sciences (NIMS), Telangana, India
| | - Pavan Swamygowda
- Department of Neurosurgery, Nizam’s Institute of Medical Sciences (NIMS), Telangana, India
| | - VVSRK Prasad
- Department of Neurology, Citi Neuro Centre, Telangana, India
| | - Sai Sri Lakshmi Meka
- Department of Neurology, Government Medical College, Ananthapuram, Andhra Pradesh, India
| | - Syed T. Fathima
- Department of Neurology, Government Medical College, Ananthapuram, Andhra Pradesh, India
| | - Rupam Borgohain
- Department of Neurology, Citi Neuro Centre, Telangana, India
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11
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Kandadai RM, Meka SS, Kola S, Alugolu R, Borgohain R. Constant Current Versus Constant Voltage DBS Stimulators-Changing Trend. Ann Indian Acad Neurol 2023; 26:368-369. [PMID: 37970242 PMCID: PMC10645276 DOI: 10.4103/aian.aian_508_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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Rukmini M. Kandadai
- Departments of Neurology and Neurosurgery, Parkinson’s Disease and Movement Disorders Research Centre, Citi Neuro Centre, Hyderabad, Telangana, India
| | - Sai S. Meka
- Departments of Neurology and Neurosurgery, Parkinson’s Disease and Movement Disorders Research Centre, Citi Neuro Centre, Hyderabad, Telangana, India
| | - Sruthi Kola
- Departments of Neurology and Neurosurgery, Parkinson’s Disease and Movement Disorders Research Centre, Citi Neuro Centre, Hyderabad, Telangana, India
| | - Rajesh Alugolu
- Departments of Neurology and Neurosurgery, Parkinson’s Disease and Movement Disorders Research Centre, Citi Neuro Centre, Hyderabad, Telangana, India
| | - Rupam Borgohain
- Departments of Neurology and Neurosurgery, Parkinson’s Disease and Movement Disorders Research Centre, Citi Neuro Centre, Hyderabad, Telangana, India
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12
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Wall JD, Sathirapongsasuti JF, Gupta R, Rasheed A, Venkatesan R, Belsare S, Menon R, Phalke S, Mittal A, Fang J, Tanneeru D, Deshmukh M, Bassi A, Robinson J, Chaudhary R, Murugan S, Ul-Asar Z, Saleem I, Ishtiaq U, Fatima A, Sheikh SS, Hameed S, Ishaq M, Rasheed SZ, Memon FUR, Jalal A, Abbas S, Frossard P, Fuchsberger C, Forer L, Schoenherr S, Bei Q, Bhangale T, Tom J, Gadde SGK, B V P, Naik NK, Wang M, Kwok PY, Khera AV, Lakshmi BR, Butterworth AS, Chowdhury R, Danesh J, di Angelantonio E, Naheed A, Goyal V, Kandadai RM, Kumar H, Borgohain R, Mukherjee A, Wadia PM, Yadav R, Desai S, Kumar N, Biswas A, Pal PK, Muthane UB, Das SK, Ramprasad VL, Kukkle PL, Seshagiri S, Kathiresan S, Ghosh A, Mohan V, Saleheen D, Stawiski EW, Peterson AS. South Asian medical cohorts reveal strong founder effects and high rates of homozygosity. Nat Commun 2023; 14:3377. [PMID: 37291107 PMCID: PMC10250394 DOI: 10.1038/s41467-023-38766-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 09/08/2021] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
The benefits of large-scale genetic studies for healthcare of the populations studied are well documented, but these genetic studies have traditionally ignored people from some parts of the world, such as South Asia. Here we describe whole genome sequence (WGS) data from 4806 individuals recruited from the healthcare delivery systems of Pakistan, India and Bangladesh, combined with WGS from 927 individuals from isolated South Asian populations. We characterize population structure in South Asia and describe a genotyping array (SARGAM) and imputation reference panel that are optimized for South Asian genomes. We find evidence for high rates of reproductive isolation, endogamy and consanguinity that vary across the subcontinent and that lead to levels of rare homozygotes that reach 100 times that seen in outbred populations. Founder effects increase the power to associate functional variants with disease processes and make South Asia a uniquely powerful place for population-scale genetic studies.
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Affiliation(s)
- Jeffrey D Wall
- Institute for Human Genetics, University of California, San Francisco, CA, 94143, USA.
- Dept of Ornithology and Mammology, California Academy of Sciences, San Francisco, CA, 94118, USA.
| | - J Fah Sathirapongsasuti
- MedGenome Inc., Foster City, CA, 94404, USA
- GenomeAsia 100K Foundation, Foster City, CA, 94404, USA
| | - Ravi Gupta
- MedGenome Labs Pvt. Ltd., Bengaluru, Karnataka, 560099, India
| | - Asif Rasheed
- Center for Non-Communicable Disease, Karachi, Karachi City, Sindh, 75300, Pakistan
| | - Radha Venkatesan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, Tamil Nadu, 600086, India
| | - Saurabh Belsare
- Institute for Human Genetics, University of California, San Francisco, CA, 94143, USA
| | - Ramesh Menon
- MedGenome Labs Pvt. Ltd., Bengaluru, Karnataka, 560099, India
| | - Sameer Phalke
- MedGenome Labs Pvt. Ltd., Bengaluru, Karnataka, 560099, India
| | | | - John Fang
- Thermo Fisher Scientific, Santa Clara, CA, 95051, USA
| | - Deepak Tanneeru
- MedGenome Labs Pvt. Ltd., Bengaluru, Karnataka, 560099, India
| | | | - Akshi Bassi
- MedGenome Labs Pvt. Ltd., Bengaluru, Karnataka, 560099, India
| | - Jacqueline Robinson
- Institute for Human Genetics, University of California, San Francisco, CA, 94143, USA
| | | | | | - Zameer Ul-Asar
- Center for Non-Communicable Disease, Karachi, Karachi City, Sindh, 75300, Pakistan
| | - Imran Saleem
- Center for Non-Communicable Disease, Karachi, Karachi City, Sindh, 75300, Pakistan
| | - Unzila Ishtiaq
- Center for Non-Communicable Disease, Karachi, Karachi City, Sindh, 75300, Pakistan
| | - Areej Fatima
- Center for Non-Communicable Disease, Karachi, Karachi City, Sindh, 75300, Pakistan
| | | | | | | | | | | | - Anjum Jalal
- Faisalabad Institute of Cardiology, Faisalabad, Pakistan
| | - Shahid Abbas
- Faisalabad Institute of Cardiology, Faisalabad, Pakistan
| | - Philippe Frossard
- Center for Non-Communicable Disease, Karachi, Karachi City, Sindh, 75300, Pakistan
| | - Christian Fuchsberger
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, 48109, USA
- Institute for Biomedicine, Eurac Research, Bolzano, Italy
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lukas Forer
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sebastian Schoenherr
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Qixin Bei
- Department of Molecular Biology, Genentech, South San Francisco, CA, 94080, USA
| | - Tushar Bhangale
- Department of Human Genetics, Genentech, South San Francisco, CA, 94080, USA
| | - Jennifer Tom
- Product Development Data Sciences, Genentech, South San Francisco, CA, 94080, USA
| | | | - Priya B V
- Narayana Nethralaya Foundation, Bengaluru, Karnataka, 560010, India
| | | | - Minxian Wang
- Program in Medical and Population Genetics & Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Pui-Yan Kwok
- Institute for Human Genetics, University of California, San Francisco, CA, 94143, USA
- Cardiovascular Research Institute and Department of Dermatology, University of California San Francisco, San Francisco, CA, 94143, USA
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Amit V Khera
- Harvard Medical School, Boston, MA, 02115, USA
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, MA, 02115, Boston, USA
- Verve Therapeutics, Cambridge, MA, 02139, USA
| | - B R Lakshmi
- MDCRC, Royal Care Super Speciality Hospital 1/520, Neelambur, Coimbatore, Tamil Nadu, 641062, India
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Rajiv Chowdhury
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK
| | - Emanuele di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Aliya Naheed
- Initiative for Non Communicable Diseases, Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Vinay Goyal
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
- Medanta Hospital, New Delhi, India
- Medanta, The Medicity, Gurgaon, India
| | | | | | - Rupam Borgohain
- Nizams Institute of Medical Sciences (NIMS), Hyderabad, India
| | - Adreesh Mukherjee
- Bangur Institute of Neurosciences and Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, India
| | | | - Ravi Yadav
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Soaham Desai
- Shree Krishna Hospital and Pramukhaswami Medical College, Bhaikaka University, Karamsad, Gujarat, India
| | - Niraj Kumar
- All India Institute of Medical Sciences, Rishikesh, India
| | - Atanu Biswas
- Bangur Institute of Neurosciences and Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, India
| | - Pramod Kumar Pal
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Uday B Muthane
- Parkinson and Ageing Research Foundation, Bengaluru, India
| | - Shymal K Das
- Bangur Institute of Neurosciences and Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, India
| | | | - Prashanth L Kukkle
- All India Institute of Medical Sciences, Rishikesh, India
- Manipal Hospital, Miller Road, Bengaluru, India
- Parkinson's Disease and Movement Disorders Clinic, Bengaluru, India
| | - Somasekar Seshagiri
- GenomeAsia 100K Foundation, Foster City, CA, 94404, USA
- Department of Molecular Biology, Genentech, South San Francisco, CA, 94080, USA
| | - Sekar Kathiresan
- Program in Medical and Population Genetics & Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
- Verve Therapeutics, Cambridge, MA, 02139, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Arkasubhra Ghosh
- Narayana Nethralaya Foundation, Bengaluru, Karnataka, 560010, India
| | - V Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, Tamil Nadu, 600086, India
| | - Danish Saleheen
- Center for Non-Communicable Disease, Karachi, Karachi City, Sindh, 75300, Pakistan
- Seymour, Paul and Gloria Milstein Division of Cardiology at Columbia University, New York, NY, 10032, USA
| | - Eric W Stawiski
- MedGenome Inc., Foster City, CA, 94404, USA
- GenomeAsia 100K Foundation, Foster City, CA, 94404, USA
- Department of Molecular Biology, Genentech, South San Francisco, CA, 94080, USA
- Caribou Biosciences, Berkeley, CA, 94710, USA
| | - Andrew S Peterson
- MedGenome Inc., Foster City, CA, 94404, USA.
- GenomeAsia 100K Foundation, Foster City, CA, 94404, USA.
- Department of Molecular Biology, Genentech, South San Francisco, CA, 94080, USA.
- Broadwing Bio, South San Francisco, CA, 94080, USA.
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13
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Kashyap M, Kola S, Yaranagula SD, Alugolu R, Kandadai RM, Borgohain R. Outcome of deep brain stimulation in autosomal recessive monogenic mutations in young onset Parkinson's Disease. Parkinsonism Relat Disord 2023; 112:105486. [PMID: 37321046 DOI: 10.1016/j.parkreldis.2023.105486] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023]
Affiliation(s)
| | - Sruthi Kola
- Citi Neuro Centre, Hyderabad, Telangana, 500033, India
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14
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Qamar MA, Rota S, Batzu L, Subramanian I, Falup-Pecurariu C, Titova N, Metta V, Murasan L, Odin P, Padmakumar C, Kukkle PL, Borgohain R, Kandadai RM, Goyal V, Chaudhuri KR. Chaudhuri's Dashboard of Vitals in Parkinson's syndrome: an unmet need underpinned by real life clinical tests. Front Neurol 2023; 14:1174698. [PMID: 37305739 PMCID: PMC10248458 DOI: 10.3389/fneur.2023.1174698] [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: 02/27/2023] [Accepted: 05/02/2023] [Indexed: 06/13/2023] Open
Abstract
We have recently published the notion of the "vitals" of Parkinson's, a conglomeration of signs and symptoms, largely nonmotor, that must not be missed and yet often not considered in neurological consultations, with considerable societal and personal detrimental consequences. This "dashboard," termed the Chaudhuri's vitals of Parkinson's, are summarized as 5 key vital symptoms or signs and comprise of (a) motor, (b) nonmotor, (c) visual, gut, and oral health, (d) bone health and falls, and finally (e) comorbidities, comedication, and dopamine agonist side effects, such as impulse control disorders. Additionally, not addressing the vitals also may reflect inadequate management strategies, leading to worsening quality of life and diminished wellness, a new concept for people with Parkinson's. In this paper, we discuss possible, simple to use, and clinically relevant tests that can be used to monitor the status of these vitals, so that these can be incorporated into clinical practice. We also use the term Parkinson's syndrome to describe Parkinson's disease, as the term "disease" is now abandoned in many countries, such as the U.K., reflecting the heterogeneity of Parkinson's, which is now considered by many as a syndrome.
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Affiliation(s)
- Mubasher A. Qamar
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Silvia Rota
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Lucia Batzu
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Indu Subramanian
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Parkinson’s Disease Research, Education and Clinical Centers, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, United States
| | - Cristian Falup-Pecurariu
- Faculty of Medicine, Transilvania University of Braşov, Brașov, Romania
- Department of Neurology, County Clinic Hospital, Brașov, Romania
| | - Nataliya Titova
- Department of Neurology, Neurosurgery and Medical Genetics, Federal State Autonomous Educational Institution of Higher Education “N.I. Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation, Moscow, Russia
- Department of Neurodegenerative Diseases, Federal State Budgetary Institution “Federal Center of Brain Research and Neurotechnologies” of the Federal Medical Biological Agency, Moscow, Russia
| | - Vinod Metta
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Lulia Murasan
- Faculty of Medicine, Transilvania University of Braşov, Brașov, Romania
- Department of Neurology, County Clinic Hospital, Brașov, Romania
| | - Per Odin
- Department of Neurology, University Hospital, Lund, Sweden
| | | | - Prashanth L. Kukkle
- Center for Parkinson’s Disease and Movement Disorders, Manipal Hospital, Karnataka, India, Bangalore
- Parkinson’s Disease and Movement Disorders Clinic, Bangalore, Karnataka, India
| | - Rupam Borgohain
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Rukmini Mridula Kandadai
- Department of Neurology, Nizam’s Institute of Medical Sciences, Autonomous University, Hyderabad, India
| | - Vinay Goyal
- Neurology Department, Medanta, Gurugram, India
| | - Kallo Ray Chaudhuri
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
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15
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Jost ST, Kaldenbach MA, Antonini A, Martinez-Martin P, Timmermann L, Odin P, Katzenschlager R, Borgohain R, Fasano A, Stocchi F, Hattori N, Kukkle PL, Rodríguez-Violante M, Falup-Pecurariu C, Schade S, Petry-Schmelzer JN, Metta V, Weintraub D, Deuschl G, Espay AJ, Tan EK, Bhidayasiri R, Fung VSC, Cardoso F, Trenkwalder C, Jenner P, Ray Chaudhuri K, Dafsari HS. Levodopa Dose Equivalency in Parkinson's Disease: Updated Systematic Review and Proposals. Mov Disord 2023. [PMID: 37147135 DOI: 10.1002/mds.29410] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [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: 10/28/2022] [Revised: 03/07/2023] [Accepted: 03/29/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND To compare drug regimens across clinical trials in Parkinson's disease (PD) conversion formulae between antiparkinsonian drugs have been developed. These are reported in relation to levodopa as the benchmark drug in PD pharmacotherapy as 'levodopa equivalent dose' (LED). Currently, the LED conversion formulae proposed in 2010 by Tomlinson et al. based on a systematic review are predominantly used. However, new drugs with established and novel mechanisms of action and novel formulations of longstanding drugs have been developed since 2010. Therefore, consensus proposals for updated LED conversion formulae are needed. OBJECTIVES To update LED conversion formulae based on a systematic review. METHODS The MEDLINE, CENTRAL, and Embase databases were searched from January 2010 to July 2021. Additionally, in a standardized process according to the GRADE grid method, consensus proposals were issued for drugs with scarce data on levodopa dose equivalency. RESULTS The systematic database search yielded 3076 articles of which 682 were eligible for inclusion in the systematic review. Based on these data and the standardized consensus process, we present proposals for LED conversion formulae for a wide range of drugs that are currently available for the pharmacotherapy of PD or are expected to be introduced soon. CONCLUSIONS The LED conversion formulae issued in this Position Paper will serve as a research tool to compare the equivalence of antiparkinsonian medication across PD study cohorts and facilitate research on the clinical efficacy of pharmacological and surgical treatments as well as other non-pharmacological interventions 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)
- Stefanie T Jost
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marie-Ann Kaldenbach
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neurosciences (DNS), University of Padua, Padova, Italy
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Lars Timmermann
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Per Odin
- Division of Neurology, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Regina Katzenschlager
- Department of Neurology, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders at Klinik Donaustadt, Vienna, Austria
| | - Rupam Borgohain
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital-University Health Network (UHN), Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
- Department of Parkinson's Disease & Movement Disorders Rehabilitation, Moriggia-Pelascini Hospital-Gravedona ed Uniti, Como, Italy
| | - Fabrizio Stocchi
- University and Institute for Research and Medical Care IRCCS San Raffaele, Rome, Italy
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Prashanth Lingappa Kukkle
- Center for Parkinson's Disease and Movement Disorders, Manipal Hospital, Bangalore, India
- Parkinson's Disease and Movement Disorders Clinic, Bangalore, India
| | - Mayela Rodríguez-Violante
- Insituto Nacional de Neurologia y Neurocirugia, Movement Disorders Clinic, Mexico City, Mexico
- Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Cristian Falup-Pecurariu
- Department of Neurology, Faculty of Medicine, Transilvania University of Brașov, Brașov, Romania
- Department of Neurology, County Emergency Clinic Hospital, Brașov, Romania
| | - Sebastian Schade
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
| | - Jan Niklas Petry-Schmelzer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Vinod Metta
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Parkinson's Disease Research, Education and Clinical Center (PADRECC), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Guenther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein (UKSH), Christian-Albrechts-University Kiel, Kiel, Germany
| | - Alberto J Espay
- University of Cincinnati Gardner Neuroscience Institute, Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
- Neuroscience and Behavioral Disorders (NBD) Department, Duke-NUS Medical School, Singapore, Singapore
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - Victor S C Fung
- Movement Disorder Unit, Department of Neurology, Westmead Hospital, Westmead, Australia
| | - Francisco Cardoso
- Movement Disorders Unit, Internal Medicine Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Claudia Trenkwalder
- Paracelsus-Elena-Klinik, Kassel, Germany
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Jenner
- Institute of Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - K Ray Chaudhuri
- Department of Neurology, County Emergency Clinic Hospital, Brașov, Romania
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
- NIHR Mental Health Biomedical Research Centre and Dementia Biomedical Research Unit, South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
| | - Haidar S Dafsari
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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16
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Metta V, Chung-Faye G, Ts Benamer H, Mrudula R, Goyal V, Falup-Pecurariu C, Muralidharan N, Deepak D, Abdulraheem M, Borgohain R, Chaudhuri KR. Hiccups, Hypersalivation, Hallucinations in Parkinson's Disease: New Insights, Mechanisms, Pathophysiology, and Management. J Pers Med 2023; 13:jpm13050711. [PMID: 37240881 DOI: 10.3390/jpm13050711] [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: 03/06/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/28/2023] Open
Abstract
Parkinson's disease (PD) is a chronic, progressive neurological disorder and the second most common neurodegenerative condition. We report three common but overlooked symptoms in PD-hiccups, hypersalivation, and hallucinations-in terms of their prevalence, pathophysiology, and up-to-date evidence-based treatment strategies. Whilst all these three symptoms do occur in many other neurological and non-neurological conditions, early recognition and treatment are paramount. Whilst hiccups affect 3% of healthy people, their rate of occurrence is higher (20%) in patients with PD. Hypersalivation (Sialorrhea) is another common neurological manifestation of many neurological and other neurodegenerative conditions such as motor neuron disease (MND), with a median prevalence rate of 56% (range: 32-74%). A 42% prevalence of sialorrhea is also reported in sub-optimally treated patients with PD. Hallucinations, especially visual hallucinations, are commonly reported, with a prevalence of 32-63% in PD, and a 55-78% prevalence is noted in patients with dementia with Lewy bodies (DLB), followed by tactile hallucinations, which are indicated by a sensation of crawling bugs or imaginary creatures across the skin surface. Whilst mainstay and primary management strategies for all these three symptoms are carried out through history taking, it is also essential to identify and treat possible potential triggers such as infection, minimise or avoid causative (such as drug-induced) factors, and especially carry out patient education before considering more definitive treatment strategies, such as botulinum toxin therapies for hypersalivation, to improve the quality of life of patients. This original review paper aims to provide a comprehensive overview of the disease mechanisms, pathophysiology, and management of hiccups, hypersalivation, and hallucinations in Parkinson's disease.
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Affiliation(s)
- Vinod Metta
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, King's College London, London WC2R 2LS, UK
- Kings College Hospital London, Dubai 263267, United Arab Emirates
| | - Guy Chung-Faye
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, King's College London, London WC2R 2LS, UK
- Kings College Hospital London, Dubai 263267, United Arab Emirates
| | - Hani Ts Benamer
- Department of Movement Disorders & Parkinson's Centre of Excellence, Mohammed Bin Rashid University, Dubai 263267, United Arab Emirates
| | - Rukmini Mrudula
- CNC Institute of Movement Disorders & Parkinson's Centre of Excellence, India
| | - Vinay Goyal
- Institute of Movement Disorders, Medanta Hospitals, India
| | | | | | - Desh Deepak
- Kings College Hospital London, Dubai 263267, United Arab Emirates
| | | | - Rupam Borgohain
- CNC Institute of Movement Disorders & Parkinson's Centre of Excellence, India
| | - Kallol Ray Chaudhuri
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, King's College London, London WC2R 2LS, UK
- Kings College Hospital London, Dubai 263267, United Arab Emirates
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17
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kola S, Prakash RR, Alugolu R, Kandadai RM, Borgohain R. Changes in Optimal Stimulation Frequency With Time for Gait Disturbances in Patients With PD After STN DBS - A Longitudinal Study. Neuromodulation 2023. [DOI: 10.1016/j.neurom.2023.02.064] [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: 04/08/2023]
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18
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Fatima TSD, Fathima ST, Kandadai RM, Borgohain R, Sreenu B, Kutala VK. Association of Catechol-O-Methyltransferase Gene Polymorphisms and Haplotypes in the Levodopa-Induced Adverse Events in Subjects with Parkinson's Disease. Indian J Clin Biochem 2023; 38:262-274. [PMID: 37025429 PMCID: PMC10070583 DOI: 10.1007/s12291-022-01046-8] [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: 02/23/2022] [Accepted: 04/17/2022] [Indexed: 11/30/2022]
Abstract
The presence of dyskinesia is the most common side effect of chronic administration of levodopa in Parkinson's disease (PD) subjects. Genetic polymorphisms in levodopa metabolizing gene, catechol-O-methyl transferase (COMT), is shown to influence the inter-individual variability in drug response and adverse events. In the present study, the association of COMT rs6269, rs4633, rs4818, and rs4680 polymorphisms and haplotypes on pharmacokinetics and adverse events with levodopa was investigated in 150 PD patients. The age of onset of PD was 58.00 ± 10 yrs. The most common side effect faced by 78% of the subjects was dyskinesia. The AUC of levodopa was found to be significantly higher in subjects with dyskinesia (1695 ± 113 ng/ml/hr, p < 0.0001) than those without dyskinesia (1550 ± 122 ng/ml/hr). We found that the frequency of subjects presenting dyskinesia was significantly higher in subjects carrying variant genotype of COMT rs6269, rs4633, and rs4680 than that with wild genotype and these subjects presented higher AUC of levodopa. In addition, in subjects with dyskinesia, the AUC of levodopa was found to be significantly higher with low COMT (ACCG) haplotype. The association of COMT rs6269, COMT rs4633, COMT rs4818, and COMT rs4680 variant genotypes with the risk of dyskinesia due to levodopa therapy showed an ROC AUC of 0.67 indicating the moderate prediction of dyskinesia (p = 0.0021) with these COMT variants. In conclusion, PD subjects carrying the variant genotypes of COMT strongly influence high levodopa-induced dyskinesia. Hence the genotyping of COMT before the levodopa therapy will be useful to reduce the adverse events associated with the chronic levodopa treatment.
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Affiliation(s)
- Tasneem SD Fatima
- Department of Clinical Pharmacology and Therapeutics, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana 500082 India
| | - Syed Tazeem Fathima
- Department of Neurology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana 500082 India
| | - Rukmini Mridula Kandadai
- Department of Neurology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana 500082 India
| | - Rupam Borgohain
- Department of Neurology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana 500082 India
| | - Boddupally Sreenu
- Department of Clinical Pharmacology and Therapeutics, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana 500082 India
| | - Vijay Kumar Kutala
- Department of Biochemistry, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana 500082 India
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19
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Meka SSL, Kandadai RM, Alugolu R, Haragopal VV, Borgohain R. Effect of Medication and Deep Brain Stimulation on Gait in Parkinson's Disease and its Quantitative Analysis Using Mobishoe - A Comparative Study. Ann Indian Acad Neurol 2023; 26:156-160. [PMID: 37179671 PMCID: PMC10171014 DOI: 10.4103/aian.aian_769_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: 09/13/2022] [Revised: 01/07/2023] [Accepted: 02/03/2023] [Indexed: 03/31/2023] Open
Abstract
Background Movement abnormalities pertaining to balance, posture, and gait are observed in Parkinson's disease patients. Gait characteristics vary widely and their analysis has been performed traditionally in gait labs. Freezing and festination usually occur at an advanced stage of the disease and are associated with reduced quality of life. Therapeutic strategies and surgical interventions are often modulated by the physician depending upon the clinical manifestations. Introduction of accelerometers and wireless data transmission systems made quantitative gait analysis possible and cost-effective. Objective To assess spatiotemporal gait parameters (step height, length (spatial), and swing support time of each foot and double support time (temporal)) in subjects who underwent deep brain stimulation surgery using a purpose-built instrument-Mobishoe. Methods A simple footwear-based gait sensing device-Mobishoe was built in-house. Thirty-six participants were included in the study after obtaining consent. Participants were made to wear Mobishoe and walk an empty corridor of 30m before Deep Brain Stimulation (DBS) in the drug on and off stated and post DBS in DBS stimulation on and medication off state (B1M0), DBS stimulation off-medication off state (B0M0), DBS stimulation off-medication on (B0M1), and DBS stimulation on and on medication (B1M1). Data was electronically captured and analyzed offline in MATrix LABoratory (MATLAB). Various gait parameters were extracted and analyzed. Results Improvement in gait parameters was observed when the subject was on medication, on stimulation, or on both when compared to baseline. Improvement was similar with both medication and stimulation and was synergistic when both were used. Significant improvement was noted in spatial characteristics when the subjects were on both the treatments, which is the ideal treatment modality. Conclusion Mobishoe is an affordable device which can measure spatiotemporal characteristics of gait. The best improvement was seen when the subjects were on both the treatment groups and the improvement can be justified as a synergistic effect of stimulation and medication.
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Affiliation(s)
- Sai Sri Lakshmi Meka
- Department of Neurology, Nizam’s Institute of Medical Sciences (NIMS), Telangana, India
| | | | - Rajesh Alugolu
- Department of Neurosurgery, Nizam’s Institute of Medical Sciences (NIMS), Telangana, India
| | - V. V. Haragopal
- Department of Statistics, Osmania University, Telangana, India
| | - Rupam Borgohain
- Department of Neurology, Nizam’s Institute of Medical Sciences (NIMS), Telangana, India
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20
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Shah V, Alugolu R, Arora A, Kandadai RM, Mudumba V, Borgohain R. 3T MRI-SWI based volumetric analysis of the subthalamic and red nuclei in advanced Parkinson's disease. J Neurosurg Sci 2023; 67:108-112. [PMID: 32401475 DOI: 10.23736/s0390-5616.20.04935-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative disease mainly involving the dopaminergic neurons of the substantia nigra. The subthalamic nucleus (STN) also plays an important role in the disease process and now is an important target for the surgical management of the disease. However, not much is known about its morphology as the disease progresses. The aim of this study was to evaluate the volume of STN and red nucleus (RN) on 3T MRI SWI and its possible correlation with the disease in patients with advanced Parkinson's disease. METHODS A total of 30 patients were enrolled. They were evaluated by analysis of symptomatology, UPDRS III, MOCA. Radiological evaluation included volumetric SWI images in 3T MRI. The volumes of the STN and RN were measured on SWI coronal images. RESULTS There were 24 (80%) males and 6 (20%) females. The mean volumes of STN and RN were 118.66 mm3 (80-170 mm3) and 379.66 mm3 (270-500 mm3). There was no significant difference between right and left STN volumes and RN volumes. There was a significant positive correlation between the disease duration and RN volumes (P=0.015) and STN volumes (in 6-13 years) (P=0.001). STN and RN volumes were negatively correlated with MOCA scores in males (P=0.008 and P=0.017), with no such correlation in females. In late-onset PD, there was a significant positive correlation between RN volume and UPDRS OFF and ON scores (P=0.028 and P=0.03). CONCLUSIONS STN volumes show a positive trend as the disease duration increases and cognition declines. RN volumes also increase as the disease progresses.
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Affiliation(s)
- Varshesh Shah
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Rajesh Alugolu
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, India -
| | - Abhishek Arora
- Department of Radiology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Rukmini M Kandadai
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | | | - Rupam Borgohain
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
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21
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Kola S, Meka SSL, Fathima ST, Wahed A, Kandadai RM, Borgohain R. Mitochondrial Membrane Protein-Associated Neurodegeneration (MPAN): Two Phenotypes-Dystonia and Spastic Paraparesis. Ann Indian Acad Neurol 2022; 25:1200-1202. [PMID: 36911454 PMCID: PMC9996515 DOI: 10.4103/aian.aian_658_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sruthi Kola
- Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India
| | - Sai S. L. Meka
- Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India
| | - Syed T. Fathima
- Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India
| | - Abdul Wahed
- Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India
| | - Rukmini M. Kandadai
- Department of Neurology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India
| | - Rupam Borgohain
- Department of Neurology, Citi Neuro Center, Hyderabad, Telangana, India
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22
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Kukkle PL, Geetha TS, Chaudhary R, Sathirapongsasuti JF, Goyal V, Kandadai RM, Kumar H, Borgohain R, Mukherjee A, Oliver M, Sunil M, Mootor MFE, Kapil S, Mandloi N, Wadia PM, Yadav R, Desai S, Kumar N, Biswas A, Pal PK, Muthane UB, Das SK, Sakthivel Murugan SM, Peterson AS, Stawiski EW, Seshagiri S, Gupta R, Ramprasad VL, Prai PRAOI. Genome-Wide Polygenic Score Predicts Large Number of High Risk Individuals in Monogenic Undiagnosed Young Onset Parkinson's Disease Patients from India. Adv Biol (Weinh) 2022; 6:e2101326. [PMID: 35810474 DOI: 10.1002/adbi.202101326] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 12/26/2021] [Revised: 05/15/2022] [Indexed: 01/28/2023]
Abstract
Parkinson's disease (PD) is a genetically heterogeneous neurodegenerative disease with poorly defined environmental influences. Genomic studies of PD patients have identified disease-relevant monogenic genes, rare variants of significance, and polygenic risk-associated variants. In this study, whole genome sequencing data from 90 young onset Parkinson's disease (YOPD) individuals are analyzed for both monogenic and polygenic risk. The genetic variant analysis identifies pathogenic/likely pathogenic variants in eight of the 90 individuals (8.8%). It includes large homozygous coding exon deletions in PRKN and SNV/InDels in VPS13C, PLA2G6, PINK1, SYNJ1, and GCH1. Eleven rare heterozygous GBA coding variants are also identified in 13 (14.4%) individuals. In 34 (56.6%) individuals, one or more variants of uncertain significance (VUS) in PD/PD-relevant genes are observed. Though YOPD patients with a prioritized pathogenic variant show a low polygenic risk score (PRS), patients with prioritized VUS or no significant rare variants show an increased PRS odds ratio for PD. This study suggests that both significant rare variants and polygenic risk from common variants together may contribute to the genesis of PD. Further validation using a larger cohort of patients will confirm the interplay between monogenic and polygenic variants and their use in routine genetic PD diagnosis and risk assessment.
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Affiliation(s)
- Prashanth Lingappa Kukkle
- Department of Neurology, Manipal Hospital, Miller Road, Bangalore, 560052, India.,Department of Neurology, Parkinson's Disease and Movement Disorders Clinic, Bangalore, 560010, India.,Department of Neurology, All India Institute of Medical Sciences, Rishikesh, 249201, India
| | - Thenral S Geetha
- Research and Diagnostics Department, MedGenome Labs Pvt Ltd, Bangalore, 560099, India
| | - Ruchi Chaudhary
- Research Department, MedGenome Inc., 348 Hatch Drive, Foster City, CA, 94404, USA
| | | | - Vinay Goyal
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110608, India.,Department of Neurology, Medanta Hospital, New Delhi, 110047, India.,Department of Neurology, Medanta, The Medicity, Gurgaon, 122006, India
| | | | - Hrishikesh Kumar
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, 700007, India
| | - Rupam Borgohain
- Department of Neurology, Nizams Institute of Medical Sciences (NIMS), Hyderabad, 500082, India
| | - Adreesh Mukherjee
- Department of Neurology, Bangur Institute of Neurosciences and Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, 700020, India
| | - Merina Oliver
- Research and Diagnostics Department, MedGenome Labs Pvt Ltd, Bangalore, 560099, India
| | - Meeta Sunil
- Research and Diagnostics Department, MedGenome Labs Pvt Ltd, Bangalore, 560099, India
| | | | - Shruti Kapil
- Research and Diagnostics Department, MedGenome Labs Pvt Ltd, Bangalore, 560099, India
| | - Nitin Mandloi
- Research and Diagnostics Department, MedGenome Labs Pvt Ltd, Bangalore, 560099, India
| | - Pettarusp M Wadia
- Department of Neurology, Jaslok Hospital and Research Centre, Mumbai, 400026, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Soaham Desai
- Department of Neurology, Shree Krishna Hospital and Pramukhswami Medical College, Bhaikaka University, Karamsad, 388325, India
| | - Niraj Kumar
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, 249201, India
| | - Atanu Biswas
- Department of Neurology, Bangur Institute of Neurosciences and Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, 700020, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Uday B Muthane
- Department of Neurology, Parkinson and Ageing Research Foundation, Bangalore, 560095, India
| | - Shymal Kumar Das
- Department of Neurology, Bangur Institute of Neurosciences and Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, 700020, India
| | | | - Andrew S Peterson
- Research Department, MedGenome Inc., 348 Hatch Drive, Foster City, CA, 94404, USA
| | - Eric W Stawiski
- Research Department, MedGenome Inc., 348 Hatch Drive, Foster City, CA, 94404, USA
| | | | - Ravi Gupta
- Research and Diagnostics Department, MedGenome Labs Pvt Ltd, Bangalore, 560099, India
| | - Vedam L Ramprasad
- Research and Diagnostics Department, MedGenome Labs Pvt Ltd, Bangalore, 560099, India
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Metta V, Chaudhuri KR, Leta V, Mridula KR, Koduri C, Deepak S, Kalpala R, Reddy N, Chung-Faye G, Borgohain R. Real-life benefits of intrajejunal levodopa infusion therapy in four patients with the parkinsonian variant of progressive supranuclear palsy: A 1-year follow-up data report. Brain Behav 2022; 12:e2547. [PMID: 35943202 PMCID: PMC9480946 DOI: 10.1002/brb3.2547] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is a progressive neurodegenerative condition presenting with different clinical endophenotypes. The parkinsonian variant of PSP (PSP-P) is characterised by early but fading responsiveness to high-dose levodopa therapy; however, high-dose oral therapy is often associated with intolerance due to dopaminergic side effects and so doses may have to be capped despite clinical benefits. Evidence from animal models and real-life registries suggest far higher doses of levodopa can be tolerated if given in a continuous drug delivery (CDD) manner. We investigated tolerance and possible clinical benefits in patients with PSP-P still responsive to levodopa after initiating CDD in the form of intrajejunal levodopa infusion (IJLI) therapy as part of a compassionate usage program (CU). METHODS This is an observational clinical data report from the IJLI implementation program undertaken in regional tertiary referral Parkinson's centres in India and at King's College Hospital London, Dubai as part of a CU. Four patients with PSP-P receiving IJLI as a part of a CU underwent evaluations of liver and renal function, motor and nonmotor function, quality of life, sleep dysfunction, fatigue, anxiety and depression, and cognitive impairment at baseline and 6 and 12 months post-IJLI initiation. RESULTS In total, three out of four patients successfully completed 12 months of treatment (6 months in one patient). All four patients showed good tolerability to IJLI even at higher doses (1400 and 1960 mg at 6 and 12 months, respectively) when compared to oral levodopa (812.5 ± 103 levodopa equivalent daily dose [LEDD]) and presented with overall persistent improvements in motor and nonmotor scores and quality-of-life scores at 6 and 12 months post-IJLI. All patients showed improvement in estimated glomerular filtration rate (43.50 ml/min/1.73 m2 to 67.5 ml/min/1.73 m2 and 79.5 ml/min/1.73 m2 at 6 and 12 months, respectively). CONCLUSIONS IJLI led to persistent beneficial effects on motor and some nonmotor aspects in patients with PSP-P at up to 12 months after treatment with associated improvement in overall renal function.
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Affiliation(s)
- Vinod Metta
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Valentina Leta
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | | | | | - Sai Deepak
- Asian Institute of Gastroenterology, Hyderabad, India
| | | | | | - Guy Chung-Faye
- Department of Gastroenterology, King's College Hospital, London, UK
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24
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Metta V, Ibrahim H, Loney T, Benamer HTS, Alhawai A, Almuhairi D, Al Shamsi A, Mohan S, Rodriguez K, Mohan J, O’Sullivan M, Muralidharan N, Al Mazrooei S, Dar Mousa K, Chung-Faye G, Mrudula R, Falup-Pecurariu C, Rodriguez Bilazquez C, Matar M, Borgohain R, Chaudhuri KR. First Two-Year Observational Exploratory Real Life Clinical Phenotyping, and Societal Impact Study of Parkinson’s Disease in Emiratis and Expatriate Population of United Arab Emirates 2019–2021: The EmPark Study. J Pers Med 2022; 12:jpm12081300. [PMID: 36013249 PMCID: PMC9410099 DOI: 10.3390/jpm12081300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Phenotypic differences in Parkinson’s Disease (PD) among locals (Emiratis) and Expatriates (Expats) living in United Arab Emirates have not been described and could be important to unravel local aspects of clinical heterogenicity of PD pointing towards genetic and epigenetic variations. Objective: To investigate the range and nature of motor and nonmotor clinical presentations of PD and its impact on time to diagnosis, local service provisions, and quality of life in Emiratis and Expats in UAE, as well as address the presence of current unmet needs on relation to care and etiopathogenesis of PD related to possible genetic and epigenetic factors. Methods: a cross-sectional one point in time prospective, observational real-life study of 171 patients recruited from PD and Neurology clinics across United Arab Emirates from 2019–2021. Primary outcomes were sociodemographic data, motor and nonmotor symptoms (NMS), including cognition and sleep, and quality of life (QOL) assessments, Results: A total of 171 PD patients (52 Emiratis 119 Expats) were included with mean age (Emiratis 48.5 (13.1) Expats 64.15 (13.1)) and mean disease duration (Emiratis 4.8 (3.2) Expats 6.1 (2.9)). In the Emiratis, there was a significant mean delay in initiating treatment after diagnosis (Emiratis 1.2 (0.9) Expats 1.6 (1.1)), while from a clinical phenotyping aspect, there is a high percentage of akinesia 25 (48.1) or tremor dominant (22 (42.3)) phenotypes as opposed to mixed subtype 67 (56.3) in Expat cohorts; double tremor dominant, especially Emirati females (25%), had a predominant lower limb onset PD. Both Emirati (27.9 (24.0)) and Expat 29.4 (15.6) showed moderate NMS burden and the NMS profile is dominated by Sleep, Fatigue, Mood, Emotional well-being 3.0 (1.1) and Social Stigma 3.5 (0.9) aspects of PDQ8 SI measurements are predicted worse QOL in Emiratis, while lack of social support 2.3 (1.3) impaired QOL in Expat population. Awareness for advanced therapies was low and only 25% of Emiratis were aware of deep brain surgery (DBS), compared to 69% Expats. Only 2% of Emiratis, compared to 32% of Expats, heard of Apomorphine infusion (CSAI), and no (0%) Emiratis were aware of intrajejunal levodopa infusion (IJLI), compared to 13% of expats. Conclusion: Our pilot data suggest clinical phenotypic differences in presentation of PD in Emiratis population of UAE compared to expats. Worryingly, the data also show delayed treatment initiation, as well as widespread lack of knowledge of advanced therapies in the Emirati population.
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Affiliation(s)
- Vinod Metta
- Psychology & Neuroscience, Department of Neurosciences, Institute of Psychiatry, King’s College London, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London, UK
- Kings College Hospital London, Dubai, United Arab Emirates
- Correspondence:
| | | | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Hani T. S. Benamer
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Ali Alhawai
- Higher Colleges of Technology, Dubai, United Arab Emirates
| | | | | | - Sneha Mohan
- Kings College Hospital London, Dubai, United Arab Emirates
| | | | - Judith Mohan
- Kings College Hospital London, Dubai, United Arab Emirates
| | | | | | | | - Khadeeja Dar Mousa
- Dubai Statistics Centre, Dubai, United Arab Emirates
- People of Determination Council (POD) Council of Dubai Police, Dubai, United Arab Emirates
| | - Guy Chung-Faye
- Psychology & Neuroscience, Department of Neurosciences, Institute of Psychiatry, King’s College London, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London, UK
- Kings College Hospital London, Dubai, United Arab Emirates
| | - Rukmini Mrudula
- Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | | | - Maryam Matar
- Genetic Disease Association, Dubai, United Arab Emirates
| | - Rupam Borgohain
- Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - K. Ray Chaudhuri
- Psychology & Neuroscience, Department of Neurosciences, Institute of Psychiatry, King’s College London, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London, UK
- Kings College Hospital London, Dubai, United Arab Emirates
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Kola S, Meka SSL, Tazeem Fathima S, Kandadai RM, Alugolu R, Borgohain R. Kufor Rakeb Syndrome with novel mutation and the role of deep brain stimulation. Mov Disord Clin Pract 2022; 9:1003-1007. [PMID: 36247915 PMCID: PMC9547128 DOI: 10.1002/mdc3.13518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/20/2022] [Accepted: 06/29/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sruthi Kola
- Department of Neurology Nizam's Institute of Medical Sciences (NIMS) Telangana India
| | - Sai Sri Lakshmi Meka
- Department of Neurology Nizam's Institute of Medical Sciences (NIMS) Telangana India
| | - Syed Tazeem Fathima
- Department of Neurology Nizam's Institute of Medical Sciences (NIMS) Telangana India
| | | | - Rajesh Alugolu
- Department of Neurosurgery Nizam's Institute of Medical Sciences (NIMS) Telangana India
| | - Rupam Borgohain
- Department of Neurology Nizam's Institute of Medical Sciences (NIMS) Telangana India
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Balakrishnan S, Aggarwal S, Muthulakshmi M, Meena AK, Borgohain R, Mridula KR, Yareeda S, Ranganath P, Dalal A. Clinical and Molecular Spectrum of Degenerative Cerebellar Ataxia: A Single Centre Study. Neurol India 2022; 70:934-942. [PMID: 35864621 DOI: 10.4103/0028-3886.349660] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cerebellar ataxia is a disabling neurological symptom with extreme clinical and etiological heterogeneity. OBJECTIVE To study the clinical and molecular characteristics in patients with degenerative cerebellar ataxia. MATERIALS AND METHODS In this study, 150 South-Indian patients with degenerative cerebellar ataxia underwent a phenotype guided, sequential tiered testing. Phenotypic features studied included cerebellar symptoms, pyramidal and extrapyramidal features, and ophthalmic and systemic findings. Tier one included conventional tests such as short PCR/fragment analysis for spinocerebellar ataxia (SCA) subtypes 1, 2, 3, 6, 7, 8, 12, 17, and 36 and TP-PCR for Friedreich ataxia (FA). Tier two testing comprised next-generation sequencing (NGS)-based strategies reserved for select undiagnosed cases. RESULTS The clinical features were highly overlapping and had limited specificity, except in autosomal recessive ataxias and SCA 34. The overall diagnostic yield of our study was 49.3%. SCA 1, 2, and 3 were noted in 13 (12.6%), 12 (11.6%) and 14 (13.5%), respectively, out of the 103 tested, and FA was noted in 17/55 (30.9%) patients. SCA subtypes 6, 7, 8, 12, 17, and 36 were absent in the cohort studied. Targeted Sanger sequencing and NGS revealed some rare diagnoses in 17 among the 18 patients tested. Whole exome sequencing uncovered a novel genotype-phenotype association in a sibling-pair with ataxia, dysmorphism, and retinopathy. CONCLUSION SCA 1, 2, 3 and FRDA were the most common causes of ataxia. SCA 6, 7, 8, 12, 17, and 36 were absent in the cohort studied. NGS testing revealed several rare forms of ataxia. Clinical features based testing is cost-effective, achieves good genotype-phenotype correlation, and prioritizes variants for further studies.
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Affiliation(s)
- Surya Balakrishnan
- Department of Medical Genetics, Nizam's institute of Medical Sciences, Hyderabad, Telangana, India
| | - Shagun Aggarwal
- Department of Medical Genetics, Nizam's institute of Medical Sciences, Hyderabad, Telangana, India
| | | | | | - Rupam Borgohain
- Department of Neurology, Nizam's institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Sireesha Yareeda
- Department of Neurology, Nizam's institute of Medical Sciences, Hyderabad, Telangana, India
| | - Prajnya Ranganath
- Department of Medical Genetics, Nizam's institute of Medical Sciences, Hyderabad, Telangana, India
| | - Ashwin Dalal
- Centre for DNA Fingerprinting and Diagnostics, Hyderabad, Telangana, India
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Olszewska DA, Rawal S, Fearon C, Alcaide‐Leon P, Stell R, Paramanandan V, Lynch T, Jawad T, Vittal P, Barton B, Miyajima H, Kono S, Kandadai RM, Borgohain R, Lang AE. Neuroimaging Pearls from the MDS Congress Video Challenge. Part 1: Genetic Disorders. Mov Disord Clin Pract 2022; 9:297-310. [PMID: 35402643 PMCID: PMC8974871 DOI: 10.1002/mdc3.13412] [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: 11/18/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 02/05/2023] Open
Abstract
We selected several "imaging pearls" presented during the Movement Disorder Society (MDS) Video Challenge for this review. While the event, as implicated by its name, was video-centered, we would like to emphasize the important role of imaging in making the correct diagnosis. We divided this anthology into two parts: genetic and acquired disorders. Genetic cases described herein were organized by the inheritance pattern and the focus was put on the imaging findings and differential diagnoses. Despite the overlapping phenotypes, certain described disorders have pathognomonic MRI brain findings that would provide either the "spot" diagnosis or result in further investigations leading to the diagnosis. Despite this, the diagnosis is often challenging with a broad differential diagnosis, and hallmark findings may be present for only a limited time.
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Affiliation(s)
- Diana A. Olszewska
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital—UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Sapna Rawal
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western HospitalUniversity Health NetworkTorontoOntarioCanada
| | - Conor Fearon
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital—UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Paula Alcaide‐Leon
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western HospitalUniversity Health NetworkTorontoOntarioCanada
| | - Rick Stell
- Movement Disorders Unit, Perron Institute of Neurological Translational ScienceSir Charles Gairdner HospitalPerthWestern AustraliaAustralia
| | | | - Tim Lynch
- Centre for Brain HealthDublin Neurological Institute at the Mater Misericordiae University HospitalDublinIreland
- School of Medicine and Medical ScienceUniversity College DublinDublinIreland
| | - Tania Jawad
- Department of NeurologyThe Royal Free HospitalLondonUnited Kingdom
| | - Padmaja Vittal
- Northwestern Medicine Central Dupage HospitalNeurodegenerative Diseases CenterWinfieldIllinoisUSA
| | - Brandon Barton
- Rush University Medical CenterChicagoIllinoisUSA
- Parkinson's Disease Research, Education, and Clinical Care ConsortiumJesse Brown VA Medical CenterChicagoIllinoisUSA
| | - Hiroaki Miyajima
- First Department of MedicineHamamatsu University School of MedicineHamamatsuJapan
| | | | | | - Rupam Borgohain
- Department of NeurologyNizam's Institute of Medical SciencesHyderabadIndia
| | - Anthony E. Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital—UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
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Kanikannan M, Reddy P, Mathukumalli N, Yareeda S, Borgohain R. Impact of Thymectomy on Crisis Incidence and Quality of Life amongst Generalised Myasthenia Gravis Patients. Neurol India 2022; 70:2427-2431. [DOI: 10.4103/0028-3886.364067] [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: 12/23/2022]
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29
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Borgohain R, Sharma M, Saikia A. Incidence of Complications of Unsafe Chronic Suppurative Otitis Media Presenting in a Tertiary Care Hospital at Assam, IndiaA Retrospective Study. J Clin Diagn Res 2022. [DOI: 10.7860/jcdr/2022/53172.16304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: Chronic otitis media is inflammation of the middle ear cleft presenting with recurrent ear discharge through a tympanic membrane perforation. The disease spectrum ranges from mild to severe forms of complications. Complications of chronic otitis media can be extracranial or intracranial. Aim: To evaluate the demographic profile of patients with chronic otitis media and to estimate the incidence of complications in upper Assam province during a period of 5 year. Materials and Methods: This retrospective study was carried out on a total of 260 patients of chronic otitis media admitted in Ear, Nose and Throat Department, Assam Medical College and Hospital, Dibrugarh, Assam, India, during a period of 5 years from August 2016 to July 2021. The data collected were tabulated in Microsoft Excel Worksheet. The categorical variables were summarised as proportions and percentages. Results: From the records, majority (31.2%) of the cases were found in the age group of 11-20 years with a male to female ratio of 1.13. The disease was more common during the winter season (56.5%). A 13.5% cases showed complications of chronic otitis media. Mastoiditis was the most common extracranial complication (31.4%) , followed by periosteal abscesses (22.9%), facial nerve paralysis (11.4%) and labyrinthitis (5.7%). Conclusion: The early identification of symptoms by rural healthcare personnels and immediate management of unsafe chronic otitis media, to avoid complications.
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Alugolu R, Vijayasaradhi M, Kolpakwar S, Kandadai R, Borgohain R. Prospective analysis of motor manifestations following STN-DBS and their correlation with electrode position. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119479] [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: 10/20/2022]
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31
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Kolpakwar S, Arora AJ, Pavan S, Kandadai RM, Alugolu R, Saradhi MV, Borgohain R. Volumetric analysis of subthalamic nucleus and red nucleus in patients of advanced Parkinson's disease using SWI sequences. Surg Neurol Int 2021; 12:377. [PMID: 34513144 PMCID: PMC8422532 DOI: 10.25259/sni_584_2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/10/2021] [Accepted: 06/29/2021] [Indexed: 11/09/2022] Open
Abstract
Background: Parkinson’s disease is associated with significant changes in morphometry of subthalamic nucleus (STN); however, not much is known as the disease progresses. The aim of present study was to investigate the volume of STN and Red nucleus (RN) on 3T-magnetic resonance imaging (MRI) and its possible correlation with disease progression in advanced Parkinson’s disease patients. Methods: Patients of advanced Parkinson’s disease were prospectively followed for clinical details, motor severity scores, and radiological evaluation. Volumes of the STN and RN were measured on susceptibility weighted imaging, coronal sections in 3T MRI and were correlated with demographic and clinical features. Results: A total of 52 patients were included in our study. There were 42 (80.77%) males and 10 (19.23%) females. Mean age of onset of Parkinson’s disease was 49.48 + 10.90 years. Average duration of disease in the present cohort was 7.65 + 4.31 years. Average STN and RN volume were 103.46 + 21.17 mm3 and 321.73 + 67.66 mm3. Age of onset, disease duration and Unified Parkinson’s Disease Rating Scale Part III scores were not found to be associated with changes in STN Volumes. Weak positive trend was noted between RN volume and disease duration (Pearson cor. 0.204, P = 0.14). Patients in early-onset Parkinson’s disease group had significantly more volume of RN than patients in late-onset Parkinson’s disease group (P = 0.014). Conclusion: Disease duration and early age of onset in Parkinson’s disease can be associated with increased RN volume. Volume of STN shows relatively no change even with disease progression.
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Affiliation(s)
- Swapnil Kolpakwar
- Department of Neurosurgery, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Abhishek J Arora
- Department of Radiology, Additional Professor, Department of Radio-Diagnosis, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - S Pavan
- Department of Neurosurgery, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Rukmini M Kandadai
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rajesh Alugolu
- Department of Neurosurgery, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - M Vijaya Saradhi
- Department of Neurosurgery, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Rupam Borgohain
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Metta V, Batzu L, Leta V, Trivedi D, Powdleska A, Mridula KR, Kukle P, Goyal V, Borgohain R, Chung-Faye G, Chaudhuri KR. Parkinson's Disease: Personalized Pathway of Care for Device-Aided Therapies (DAT) and the Role of Continuous Objective Monitoring (COM) Using Wearable Sensors. J Pers Med 2021; 11:jpm11070680. [PMID: 34357147 PMCID: PMC8305099 DOI: 10.3390/jpm11070680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 12/12/2022] Open
Abstract
Parkinson’s disease (PD) is a chronic, progressive neurological disorder and the second most common neurodegenerative condition. Advanced PD is complicated by erratic gastric absorption, delayed gastric emptying in turn causing medication overload, and hence the emergence of motor and non-motor fluctuations and dyskinesia, which is initially predictable and then becomes unpredictable. As the patient progresses to the advanced stage, advanced Parkinson’s disease (APD) is characterized by refractory motor and non motor fluctuations, unpredictable OFF periods, and troublesome dyskinesias. The management of APD is a complex affair. There is growing recognition that GI dysfunction is common in PD, with virtually the entire GI system (the upper and lower GI tracts) causing problems from dribbling to defecation. The management of PD should focus on personalized care addressing both motor and non-motor symptoms, ideally including not only dopamine replacement but also associated non-dopaminergic circuits, particularly focusing on noradrenergic, serotonergic, and cholinergic therapies bypassing the gastrointestinal tract (GIT) by infusion or device-aided therapies (DAT), including levodopa–carbidopa intestinal gel infusion, apomorphine subcutaneous infusion, and deep brain stimulation, which are available in many countries for the management of the advanced stage of Parkinson’s disease (APD). The PKG (KinetiGrap) can be used as a continuous objective monitoring (COM) aid, as a screening tool to help to identify advanced PD (APD) patients suitable for DAT, and can thus improve clinical outcomes.
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Affiliation(s)
- Vinod Metta
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK; (L.B.); (V.L.); (D.T.); (A.P.); (G.C.-F.); (K.R.C.)
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London SE5 9RS, UK
- Correspondence:
| | - Lucia Batzu
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK; (L.B.); (V.L.); (D.T.); (A.P.); (G.C.-F.); (K.R.C.)
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London SE5 9RS, UK
| | - Valentina Leta
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK; (L.B.); (V.L.); (D.T.); (A.P.); (G.C.-F.); (K.R.C.)
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London SE5 9RS, UK
| | - Dhaval Trivedi
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK; (L.B.); (V.L.); (D.T.); (A.P.); (G.C.-F.); (K.R.C.)
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London SE5 9RS, UK
| | - Aleksandra Powdleska
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK; (L.B.); (V.L.); (D.T.); (A.P.); (G.C.-F.); (K.R.C.)
| | | | | | - Vinay Goyal
- Medanta Institute of Neurosciences, New Delhi 122001, India;
| | - Rupam Borgohain
- Nizams Institute of Medical Sciences, Hyderabad 500082, India; (K.R.M.); (R.B.)
| | - Guy Chung-Faye
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK; (L.B.); (V.L.); (D.T.); (A.P.); (G.C.-F.); (K.R.C.)
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London SE5 9RS, UK
| | - K. Ray Chaudhuri
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK; (L.B.); (V.L.); (D.T.); (A.P.); (G.C.-F.); (K.R.C.)
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London SE5 9RS, UK
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van Wamelen DJ, Sauerbier A, Leta V, Rodriguez-Blazquez C, Falup-Pecurariu C, Rodriguez-Violante M, Rizos A, Tsuboi Y, Metta V, Bhidayasiri R, Bhattacharya K, Borgohain R, Prashanth LK, Rosales R, Lewis S, Fung V, Behari M, Goyal V, Kishore A, Lloret SP, Martinez-Martin P, Chaudhuri KR. Cross-sectional analysis of the Parkinson's disease Non-motor International Longitudinal Study baseline non-motor characteristics, geographical distribution and impact on quality of life. Sci Rep 2021; 11:9611. [PMID: 33953218 PMCID: PMC8100281 DOI: 10.1038/s41598-021-88651-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 11/06/2020] [Accepted: 04/12/2021] [Indexed: 01/20/2023] Open
Abstract
Growing evidence suggests that non-motor symptoms (NMS) in Parkinson’s disease (PD) have differential progression patterns that have a different natural history from motor progression and may be geographically influenced. We conducted a cross-sectional analysis of 1607 PD patients of whom 1327 were from Europe, 208 from the Americas, and 72 from Asia. The primary objective was to assess baseline non-motor burden, defined by Non-Motor Symptoms Scale (NMSS) total scores. Other aims included identifying the factors predicting quality of life, differences in non-motor burden between drug-naïve and non-drug-naïve treated patients, and non-motor phenotypes across different geographical locations. Mean age was 65.9 ± 10.8 years, mean disease duration 6.3 ± 5.6 years, median Hoehn and Yahr stage was 2 (2–3), and 64.2% were male. In this cohort, mean NMSS scores were 46.7 ± 37.2. Differences in non-motor burden and patterns differed significantly between drug-naïve participants, those with a disease duration of less than five years, and those with a duration of five years or over (p ≤ 0.018). Significant differences were observed in geographical distribution (NMSS Europe: 46.4 ± 36.3; Americas: 55.3 ± 42.8; Asia: 26.6 ± 25.1; p < 0.001), with differences in sleep/fatigue, urinary, sexual, and miscellaneous domains (p ≤ 0.020). The best predictor of quality of life was the mood/apathy domain (β = 0.308, p < 0.001). This global study reveals that while non-motor symptoms are globally present with severe NMS burden impacting quality of life in PD, there appear to be differences depending on disease duration and geographical distribution.
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Affiliation(s)
- Daniel J van Wamelen
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, UK. .,Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands. .,Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Anna Sauerbier
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Neurology, Faculty of Medicine University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Valentina Leta
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, UK
| | - Carmen Rodriguez-Blazquez
- National Center of Epidemiology, Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Cristian Falup-Pecurariu
- Department of Neurology, Faculty of Medicine, County Emergency Clinic Hospital, Transilvania University, Braşov, Romania
| | | | - Alexandra Rizos
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, UK
| | - Y Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Vinod Metta
- Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, UK
| | | | - Kalyan Bhattacharya
- Formerly RG Kar Medical College and Institute of Neuroscience, Kolkata, India
| | | | - L K Prashanth
- Center for Parkinson's Disease and Movement Disorders Clinic, Vikram Hospitals, Bangalore, India.,Parkinson's Disease and Movement Disorders Clinic, Bangalore, India
| | | | - Simon Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Victor Fung
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Madhuri Behari
- Department of Neurology, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Goyal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Asha Kishore
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Santiago Perez Lloret
- Biomedical Research Center, Interamerican Open University (CAECIHS-UAI), National Research Council (CONICET), Buenos Aires, Argentina.,Department of Physiology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, UK
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Meka S, Syed T, Kandadai R, Borgohain R. Study of variability in tremor in Parkinson's Disease population. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.205] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Syed T, Kandadai R, Syed T, Meka S, Kutala V, Borgohain R. Association of dopamine transporter gene polymorphisms with the risk of Parkinson's Disease. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.126] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Kandadai R, Ahrar K, Turaga S, Meka S, Syed T, Borgohain R. Prevalence of restless leg syndrome (RLS) in Parkinson's disease and its correlation with serum and CSF iron and ferritin levels. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.203] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Borgohain R, Syed T, Syed T, Meka S, Kandadai R. Association of dopamine receptor gene polymorphism with the risk of Parkinson's Disease. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.135] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rajan R, Divya KP, Kandadai RM, Yadav R, Satagopam VP, Madhusoodanan UK, Agarwal P, Kumar N, Ferreira T, Kumar H, Sreeram Prasad AV, Shetty K, Mehta S, Desai S, Kumar S, Prashanth LK, Bhatt M, Wadia P, Ramalingam S, Wali GM, Pandey S, Bartusch F, Hannussek M, Krüger J, Kumar-Sreelatha A, Grover S, Lichtner P, Sturm M, Roeper J, Busskamp V, Chandak GR, Schwamborn J, Seth P, Gasser T, Riess O, Goyal V, Pal PK, Borgohain R, Krüger R, Kishore A, Sharma M. Genetic Architecture of Parkinson's Disease in the Indian Population: Harnessing Genetic Diversity to Address Critical Gaps in Parkinson's Disease Research. Front Neurol 2020; 11:524. [PMID: 32655481 PMCID: PMC7323575 DOI: 10.3389/fneur.2020.00524] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 02/02/2020] [Accepted: 05/13/2020] [Indexed: 12/21/2022] Open
Abstract
Over the past two decades, our understanding of Parkinson's disease (PD) has been gleaned from the discoveries made in familial and/or sporadic forms of PD in the Caucasian population. The transferability and the clinical utility of genetic discoveries to other ethnically diverse populations are unknown. The Indian population has been under-represented in PD research. The Genetic Architecture of PD in India (GAP-India) project aims to develop one of the largest clinical/genomic bio-bank for PD in India. Specifically, GAP-India project aims to: (1) develop a pan-Indian deeply phenotyped clinical repository of Indian PD patients; (2) perform whole-genome sequencing in 500 PD samples to catalog Indian genetic variability and to develop an Indian PD map for the scientific community; (3) perform a genome-wide association study to identify novel loci for PD and (4) develop a user-friendly web-portal to disseminate results for the scientific community. Our "hub-spoke" model follows an integrative approach to develop a pan-Indian outreach to develop a comprehensive cohort for PD research in India. The alignment of standard operating procedures for recruiting patients and collecting biospecimens with international standards ensures harmonization of data/bio-specimen collection at the beginning and also ensures stringent quality control parameters for sample processing. Data sharing and protection policies follow the guidelines established by local and national authorities.We are currently in the recruitment phase targeting recruitment of 10,200 PD patients and 10,200 healthy volunteers by the end of 2020. GAP-India project after its completion will fill a critical gap that exists in PD research and will contribute a comprehensive genetic catalog of the Indian PD population to identify novel targets for PD.
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Affiliation(s)
- Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - K P Divya
- Sree Chitra Tirunal Institute for Medical Sciences, Trivandrum, India
| | | | - Ravi Yadav
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Venkata P Satagopam
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Luxembourg, Luxembourg.,ELIXIR-Luxembourg Node, Belvaux, Luxembourg
| | - U K Madhusoodanan
- Sree Chitra Tirunal Institute for Medical Sciences, Trivandrum, India
| | - Pankaj Agarwal
- Movement Disorders Clinic, Global Hospitals, Mumbai, India
| | - Niraj Kumar
- All India Institute of Medical Sciences, Rishikesh, India
| | | | | | | | - Kuldeep Shetty
- Narayana Hrudayalaya Multispeciality Hospital, Bangalore, India
| | - Sahil Mehta
- Department of Neurology, PGIMER, Chandigarh, India
| | - Soaham Desai
- Shree Krishna Hospital and Pramukhswami Medical College, Karamsad, India
| | - Suresh Kumar
- Department of Neurology, Vijaya Health Centre, Chennai, India
| | - L K Prashanth
- Center for Parkinson's Disease and Movement Disorders, Vikram Hospital, Bangalore, India
| | - Mohit Bhatt
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | | | - Sudha Ramalingam
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, India
| | - G M Wali
- Neurospecialities Centre, Belgaum, India
| | - Sanjay Pandey
- Department of Neurology, G. B. Pant Institute of Medical Education and Research, New Delhi, India
| | - Felix Bartusch
- Zentrum für Datenverarbeitung (ZDV), University of Tubingen, Tübingen, Germany
| | | | - Jens Krüger
- Zentrum für Datenverarbeitung (ZDV), University of Tubingen, Tübingen, Germany
| | - Ashwin Kumar-Sreelatha
- Centre for Genetic Epidemiology, Institute for Clinical Epidemiology and Applied Biometry, University of Tubingen, Tübingen, Germany
| | - Sandeep Grover
- Centre for Genetic Epidemiology, Institute for Clinical Epidemiology and Applied Biometry, University of Tubingen, Tübingen, Germany
| | - Peter Lichtner
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Human Genetics, Neuherberg, Germany
| | - Marc Sturm
- Institute for Medical Genetics and Applied Genomics, University of Tubingen, Tübingen, Germany
| | - Jochen Roeper
- Institute of Neurophysiology, Goethe University Frankfurt, Frankfurt, Germany
| | - Volker Busskamp
- Department of Ophthalmology, Universitäts-Augenklinik Bonn, University of Bonn, Bonn, Germany
| | | | - Jens Schwamborn
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Luxembourg, Luxembourg
| | - Pankaj Seth
- National Brain Research Centre, Gurugram, India
| | - Thomas Gasser
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Olaf Riess
- Institute for Medical Genetics and Applied Genomics, University of Tubingen, Tübingen, Germany
| | - Vinay Goyal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.,Medanta the Medicity, Gurgaon, India
| | - Pramod Kumar Pal
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Rupam Borgohain
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Rejko Krüger
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Luxembourg, Luxembourg.,Transversal Translational Medicine, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Asha Kishore
- Sree Chitra Tirunal Institute for Medical Sciences, Trivandrum, India
| | - Manu Sharma
- Department of Neurology, G. B. Pant Institute of Medical Education and Research, New Delhi, India
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Mathukumalli NL, Kandadai MR, Shaik JA, Kanikannan MA, Borgohain R. Serum B12, Homocysteine Levels, and their Effect on Peripheral Neuropathy in Parkinson's Disease: Indian Cohort. Ann Indian Acad Neurol 2020; 23:48-53. [PMID: 32055122 PMCID: PMC7001434 DOI: 10.4103/aian.aian_478_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Cobalamin deficiency, either due to dietary inadequacy or increased consumption attributable to levodopa-mediated metabolic disturbance, and resultant hyperhomocysteinemia may contribute to peripheral neuropathy (PN) in Parkinson's disease (PD). Aim: The aim of the study is to assess the prevalence of Vitamin B12 deficiency, hyperhomocysteinemia in Indian PD patients, and their association with PN. Materials and Methods: Clinical details were collected in 93 patients over a period of 2 years. Seventy controls were included in the study. Serum B12, homocysteine, folate, electroneurography, and autonomic function tests were done. The prevalence of B12 deficiency and hyperhomocysteinemia in PD patients and controls was assessed. The association of B12 and homocysteine levels with patients’ age, disease duration, levodopa equivalent daily dose, cumulative levodopa dose, Unified Parkinson's Disease Rating Scale-III off score, modified Hoehn and Yahr score, and presence or absence of PN was studied. Results: Serum B12, homocysteine levels, prevalence of B12 deficiency, and hyperhomocysteinemia were no different between cases and controls. Seven of 93 (9.68%) PD patients had PN. The median values of serum B12, folate, and homocysteine levels across patients with or without PN could not be compared as only seven of our patients had PN. Conclusion: The prevalence of B12 deficiency, hyperhomocysteinemia, and incidence of PN among our patients is very less when compared to the Western population. The conjecture that PN in PD patients may be secondary to B12 deficiency/hyperhomocysteinemia stands as a speculation.
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Affiliation(s)
| | - Mridula R Kandadai
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Jabeen A Shaik
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Meena A Kanikannan
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rupam Borgohain
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Gulati A, Agrawal N, Vibha D, Misra U, Paul B, Pandian J, Borgohain R, Lavhale M. Abstract 14: A Randomized Study to Determine Efficacy of Sovateltide (PMZ-2010) in Patients With Acute Cerebral Ischemic Stroke. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.14] [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: 11/16/2022]
Abstract
Sovateltide (IRL-1620, PMZ-1620), an endothelin-B receptor agonist, administered intravenously following acute cerebral ischemic stroke increased cerebral blood flow, had anti-apoptotic activity and produced neurovascular remodeling. Its safety and tolerability were confirmed in healthy human volunteers (CTRI/2016/11/007509). A prospective, multi-centric, randomized, double-blind, parallel, controlled clinical study to compare efficacy of sovateltide with standard treatment in patients with acute cerebral ischemic stroke (CTRI/2017/11/010654; NCT04046484) was conducted in 40 patients, of which 36 completed 90-day follow-up. Patients received saline (n=18; 11 male and 7 female) or sovateltide (n=18; 15 male and 3 female) within 24 hours of onset of stroke. Standard treatment in both cohorts was similar. Mean age in saline and sovateltide cohorts was 58.34±1.73 and 49.83±2.79 years, respectively. Number of patients receiving investigational drug within 20 hours of onset of stroke were 14/18 in saline and 10/18 in sovateltide cohorts. National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Barthel Index (BI) on day 6 when compared to day 1 showed P values of 0.0495, 0.0859 and 0.3948, respectively in saline cohort, whereas the P value in sovateltide cohort was less than 0.0001 of all three indices in sovateltide cohort. An improvement of 6 or more in NIHSS at 90 day of treatment was 57% in sovateltide and 43% patients in saline cohort (P=0.2714; Odds ratio 2.275). mRS improvement of 2 or more was observed in 60% and 40% patients in sovateltide and saline cohorts, respectively (P=0.0519; Odds ratio 5.25). BI improvement of 40 or more was 64% and 36% in sovateltide and saline cohorts, respectively (P=0.0112; Odds ratio 12.44). Number of patients with full recovery achieving NIHSS score of 0 and BI of 100 were significantly (P<0.05) more in sovateltide cohort compared to saline. Hemodynamic, biochemical or hematological parameters were not affected and no incidence of drug related adverse event with sovateltide was reported. Sovateltide (PMZ-1620) has the potential to an effective first-in-class drug that promotes quicker recovery and improves neurological outcome in acute ischemic stroke patients.
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Affiliation(s)
| | | | - Deepti Vibha
- All India Institute of Med Sciences, New Delhi, India
| | - U.K. Misra
- Sanjay Gandhi Postgraduate Institute of Med Sciences, Lucknow, India
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Mathukumali NL, Tandra SR, Yareeda S, Kandadai RM, Gaddamanugu P, Turaga S, Jabeen SA, Borgohain R. Prof. Meena Angamuthu Kanikannan. Ann Indian Acad Neurol 2020. [PMCID: PMC7313606 DOI: 10.4103/aian.aian_187_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Swetha R. Tandra
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sireesha Yareeda
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rukmini M. Kandadai
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Padmaja Gaddamanugu
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Suryaprabha Turaga
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Shaik A. Jabeen
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rupam Borgohain
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India,Address for correspondence: Prof. Rupam Borgohain, Professer and Head, Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India. E-mail:
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Metta V, Borgohain R, L Kukkle P, Mridula R, Agarwal P, Kishore A, Goyal V, Chaudhuri R. Subcutaneous apomorphine in advanced Parkinson’s disease and its use in Indian population. Ann Mov Disord 2020. [DOI: 10.4103/aomd.aomd_16_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kandadai R, Borgohain R. Ataxia telangiectasia in India—Identifying the hidden glacier. Ann Mov Disord 2020. [DOI: 10.4103/aomd.aomd_3_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Borgohain R, Mridula RK, Sd T, Syed T, Kutala V. Association of genetic polymorphism with pharmacokinetics of Levodopa in South Indian Parkinson's disease population. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1330] [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: 10/25/2022]
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45
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Kanikannan MA, Arepareddy PK, Mathukumalli NL, Y S, Kandadai RM, Jabeen AS, T S, Borgohain R. Validation of the 2015 diagnostic criteria for neuromyelitis optica spectrum disorders in a cohort of South Indian patients. Mult Scler Relat Disord 2019; 35:164-169. [DOI: 10.1016/j.msard.2019.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/16/2019] [Accepted: 07/27/2019] [Indexed: 01/19/2023]
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Naik GS, Meena AK, Reddy BAK, Mridula RK, Jabeen SA, Borgohain R. Anti-ganglioside antibodies profile in Guillain-Barré syndrome: Correlation with clinical features, electrophysiological pattern, and outcome. Neurol India 2019; 65:1001-1005. [PMID: 28879885 DOI: 10.4103/neuroindia.ni_1226_15] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) and its subtypes are associated with distinct anti-ganglioside antibodies. Hence, we aimed to determine the frequency of anti-ganglioside antibodies and its correlation with clinical features, electrophysiological patterns, and outcome in patients with GBS. MATERIAL AND METHODS The data regarding clinical features, electrophysiological patterns, and outcome at 6 months were collected and analyzed from the case records of patients diagnosed with GBS during 2008-2013 at a tertiary care hospital in south India. RESULTS A total of 204 patients with GBS were studied, and 73 patients (mean age: 37.6 ± 17.5 years) who underwent anti-ganglioside antibody testing were analyzed. Male-to-female ratio was 2.5:1. IgG anti-ganglioside antibodies were positive in 41/73 patients. The most common IgG anti-ganglioside antibody observed in the acute demyelinating variant was anti-GT1b (n = 13; 17.8%), and, those in the acute axonal variant were anti-GM1, anti-GM2, anti-GD1b, and anti-GT1b antibodies (n = 9;12.3% each). Three patients died and 5 patients were unable to walk independently at the end of 6 months. CONCLUSIONS The frequency of anti-ganglioside antibodies in our cohort with GBS was 56%, with IgG anti-GT1b antibody being the most common. The anti-ganglioside antibodies were significantly positive in acute motor axonal neuropathy (AMAN) subtype of GBS. The presence of anti-ganglioside antibodies was not found to be of significant use in predicting the outcome. Although it was observed that the absence, and not the presence, of anti-ganglioside antibodies was associated with antecedent infection, dysautonomia, and requirement of ventilator support, the overall disease severity was not antibody dependant.
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Affiliation(s)
- G Sivaram Naik
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - A Kanikannan Meena
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - B Ashok Kumar Reddy
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rukmini K Mridula
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Shaik A Jabeen
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rupam Borgohain
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Hui M, Meena AK, Rajasekhar L, Sireesha Y, Afshan J, Mridula R, Borgohain R, Uppin MS. Vasculitic Neuropathy: A Retrospective Analysis of Nerve Biopsies and Clinical Features from a Single Tertiary Care Center. Ann Indian Acad Neurol 2019; 22:180-186. [PMID: 31007430 PMCID: PMC6472243 DOI: 10.4103/aian.aian_47_18] [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] [Indexed: 11/04/2022] Open
Abstract
Objective Vasculitic neuropathy can be either restricted to the peripheral nerves or associated with systemic involvement of other organs. The objective of this study was to analyze the nerve biopsies reported as "vasculitic neuropathy" with clinical features. Materials and Methods All cases diagnosed with vasculitic neuropathy were retrospectively analyzed and categorized as systemic vasculitis and nonsystemic vasculitic neuropathy based on the clinical features. The histological features were further evaluated and classified according to the Peripheral Nerve Society Guidelines. Results Of the 126 cases, there were 65 nonsystemic vasculitis, 45 secondary systemic vasculitis, and 16 primary systemic vasculitis. Definite vasculitis was more common in the systemic vasculitis group. The epineurial vessels were predominantly involved with chronic axonal changes. Conclusion The sensitivity of definite vasculitis on nerve biopsy was 54.76%. The sensitivity increases when the diagnostic criteria of definite and probable vasculitis were applied taking into account perivascular inflammation accompanied by vascular changes and axonopathy.
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Affiliation(s)
- Monalisa Hui
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - A K Meena
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Liza Rajasekhar
- Department of Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Yareeda Sireesha
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Jabeen Afshan
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rukmini Mridula
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rupam Borgohain
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Megha S Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Sireesha Y, Kanikannan MA, Pyal A, Sandeep G, Uppin MS, Kandadai RM, Jabeen SA, Varaprasad R, Rajasekhar L, Neeharika ML, Borgohain R. Patterns of peripheral neuropathy in Sjogren's syndrome in a tertiary care hospital from South India. Neurol India 2019; 67:S94-S99. [PMID: 30688241 DOI: 10.4103/0028-3886.250714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction Sjogren's syndrome (SS) is a systemic autoimmune disease that apart from involving the exocrine glands can affect any organ. Involvement of the peripheral nervous system results in a wide spectrum of neuropathic manifestations. Objective To evaluate the clinico-electrophysiological patterns as well as pathological characteristics of neuropathy in SS patients presenting to a neuromuscular clinic in a tertiary hospital from South India. Materials and Methods This is a retrospective study from the Departments of Neurology, Rheumatology, and Pathology from Nizam's Institute of Medical Sciences. Twenty-one patients with the diagnosis of SS and peripheral neuropathy, seen between 2010 and 2016 were analyzed. Clinical records, conventional nerve conduction studies, and lip and nerve biopsy reports were collected. Results Twenty one patients with SS had associated neuropathy. Female-to-male ratio was 2:1. In 14 (66.7%) patients, neuropathy was the initial manifestation, while in 4 (20%), exocrinopathy preceded neuropathy. The patterns of neuropathy included mononeuropathy multiplex (MNM) in 7 patients (30%), ganglionopathy in 4 (20%), length-dependant trigeminal autonomic neuropathy, and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) in 2 (10%), and cranial neuropathy in 1 (10%). Eighteen (86%) were seropositive with either anti Ro/SS-A or anti La/SS-B antibodies. Schirmer's test was positive in 13 (61.9%) patients. Nerve biopsy showed vasculitis in 5 patients and demyelinating and axonopathy in 2 patients each. Conclusions We conclude that neuropathy is frequently the initial presentation of SS. MNM is the most common pattern followed by ganglionopathy. The pattern of neuropathy helps in arriving at the diagnosis of SS. Serology is a useful initial laboratory test. However,confirmation of SS is not by mere serology. Schirmer's test and lip biopsy are equally essential for the diagnosis, especially in seronegative patients when the clinical index of suspicion is high.
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Affiliation(s)
- Yareeda Sireesha
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Anjan Pyal
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Gampa Sandeep
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Megha S Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Shaik Afshan Jabeen
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rajendra Varaprasad
- Department of Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Liza Rajasekhar
- Department of Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Rupam Borgohain
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Kandadai R, Bethala A, Sirineni D, Turaga S, Jabeen S, Kanikannan M, Borgohain R. Change in non-motor symptoms after deep brain stimulation of bilateral subthalamic nuclei in patients with Parkinson’s disease. Ann Mov Disord 2019. [DOI: 10.4103/aomd.aomd_4_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kandadai R, Tandra S, Peddisetty R, Babu KJ, Prabha TS, Jabeen SA, Meena AK, Borgohain R. The effect of dual tasking and deep brain stimulation frequency parameters on gait in advanced parkinson's disease. Ann Indian Acad Neurol 2019; 23:308-312. [PMID: 32606517 PMCID: PMC7313555 DOI: 10.4103/aian.aian_11_19] [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: 01/05/2019] [Revised: 03/20/2019] [Accepted: 03/24/2019] [Indexed: 11/23/2022] Open
Abstract
Objective: To study the effect of dual tasking and deep brain stimulation frequency parameters on gait in advanced Parkinson's disease Materials and Methods: This is an open label interventional study evaluating 40 post STN-DBS patients with gait disturbances. All patients were diagnosed as PD by a movement disorder specialist using the United Kingdom Parkinson's Disease Society Brain Bank (UKPDSBB) criteria. Patients underwent bilateral subthalamic deep brain stimulation by a qualified neurosurgeon. Patients were managed on a combination of dopamine replacement therapy as well as deep brain stimulation. Patients were assessed by stand walk sit (SWS) test for a 5 meter distance and FOG scoring during medication 'ON' state and device “ON” state, at four frequencies 180, 130, 90, 60 HZ and device “OFF” state. Results: Out of 40 patients, 38 patients showed a significant improvement in gait at a single frequency (best response frequency) which is different for each patient. The mean FOG score showed significant improvement at all stimulation frequencies when compared to OFF stimulation (P < 0.05). The mean number of steps was 18.9 at best response frequency and 21.48 at 130 Hz (P < 0.0001). Number of freezing episodes also were significantly less with best frequency when compared to 130 Hz stimulation (0.28 and 0.65 respectively, (P < 0.0001). The mean FOG score was 6.45 at best frequency and 9.48 at 130 Hz (P < 0.0001). Mean Dual tasking score was 3.53 at best frequency and 5.15 at 130 Hz (P < 0.0002). Conclusion: Optimization of frequency setting for each patient can improve gait and that each patient may have a different optimal frequency.
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