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Surisetti BK, Prasad S, Holla VV, Kamble N, Yadav R, Pal PK. Movement Disorders Associated With Radiotherapy and Surgical Procedures. J Mov Disord 2023; 16:42-51. [PMID: 36628430 PMCID: PMC9978251 DOI: 10.14802/jmd.22092] [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: 06/17/2022] [Accepted: 11/27/2022] [Indexed: 01/12/2023] Open
Abstract
Occasionally, movement disorders can occur following interventional procedures including but not limited to radiotherapy, dental procedures, and cardiac, cerebral and spinal surgeries. The majority of these disorders tend to be unexpected sequelae with variable phenomenology and latency, and they can often be far more disabling than the primary disease for which the procedure was performed. Owing to poor knowledge and awareness of the problem, delays in diagnosing the condition are common, as are misdiagnoses as functional movement disorders. This narrative review discusses the phenomenology, pathophysiology, and potential treatments of various movement disorders caused by interventional procedures such as radiotherapy and neurological and non-neurological surgeries and procedures.
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Affiliation(s)
- Bharath Kumar Surisetti
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Shweta Prasad
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India,Department of Clinical Neurosciences, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Vikram Venkappayya Holla
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India,Corresponding author: Pramod Kumar Pal, MD, DNB, DM, FRCP Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bengaluru, Karnataka 560029, India / Tel: +91-80-26995147 / Fax: +91-80-26564830 / E-mail:
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Holla VV, Neeraja K, Prasad S, Surisetti BK, Sharma D, Kamble N, Kulanthaivelu K, Dwarakanth S, Pruthi N, Pal PK, Yadav R. In Reply to the Letter to the Editor Regarding "Cervical Myeloradiculopathy and Atlantoaxial Instability in Cervical Dystonia". World Neurosurg 2021; 157:263. [PMID: 34929783 DOI: 10.1016/j.wneu.2021.10.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Vikram Venkappayya Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Koti Neeraja
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Shweta Prasad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India; Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Bharath Kumar Surisetti
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Dinesh Sharma
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Karthik Kulanthaivelu
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Srinivas Dwarakanth
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Nupur Pruthi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India.
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Surisetti BK, Holla VV, Prasad S, Neeraja K, Kamble N, Yadav R, Pal PK. Clinical and Imaging Profile of Patients with Joubert Syndrome. J Mov Disord 2021; 14:231-235. [PMID: 34592808 PMCID: PMC8490194 DOI: 10.14802/jmd.21066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Joubert syndrome (JS) is a rare syndrome characterized by ataxia and the molar tooth sign (MTS) on imaging. The present study aims to explore the clinical and radiological features in a cohort of patients with JS. METHODS This was a retrospective chart review of patients with JS evaluated by movement disorder specialists. RESULTS Nine patients were included in the study. All patients had facial dysmorphism and ocular abnormalities, and 4 patients had dystonia. Ocular tilt reaction and alternate skew deviation (66%) were the most common ocular abnormalities. Horizontally aligned superior cerebellar peduncles were observed in all four patients with diffusion tensor imaging, with a lack of decussation in three. Exome sequencing performed in four patients revealed novel variants in the MKS1, CPLANE1, and PIBF1 genes. CONCLUSION Facial dysmorphism, ocular abnormalities and classical imaging findings were observed in all patients with JS. Apart from ataxia, dystonia and myoclonus are other movement disorders observed in JS.
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Affiliation(s)
- Bharath Kumar Surisetti
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Karnataka, India
| | - Vikram Venkappayya Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Karnataka, India
| | - Shweta Prasad
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Karnataka, India
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Karnataka, India
| | - Koti Neeraja
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Karnataka, India
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Holla VV, Surisetti BK, Prasad S, Pal PK. Focal dystonia in a case of SYNE1 spastic-ataxia: Expanding the phenotypic spectrum. Parkinsonism Relat Disord 2021; 87:22-24. [PMID: 33933852 DOI: 10.1016/j.parkreldis.2021.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 04/02/2021] [Accepted: 04/11/2021] [Indexed: 11/24/2022]
Abstract
Synaptic nuclear envelope protein-1 (SYNE1) related cerebellar ataxia also called ARCA1 or SCAR8, manifests as a relatively pure cerebellar ataxia or with additional neurological involvement. Dystonia is rarely seen in SYNE1 ataxia and to the best of our knowledge, there are only three reports of dystonia in patients with SYNE1 ataxia. This report describes a 22-year-old woman with chronic progressive spastic-ataxia of 3-year duration with additional focal dystonia of the right upper limb. Patient had cerebellar atrophy on MRI brain and a novel pathogenic homozygous variant in exon 74 of the SYNE1 gene (p.Gln4047Ter).
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Affiliation(s)
- Vikram V Holla
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bengaluru, 560029, Karnataka, India
| | - Bharath Kumar Surisetti
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bengaluru, 560029, Karnataka, India
| | - Shweta Prasad
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bengaluru, 560029, Karnataka, India; Department of Clinical Neurosciences, National Institute of Mental Health & Neurosciences, Hosur Road, Bengaluru, 560029, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bengaluru, 560029, Karnataka, India.
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Surisetti BK, Prasad S, Holla VV, Neeraja K, Kamble N, Netravathi M, Yadav R, Pal PK. Clinical and Imaging Profile of Patients with Palatal Tremor. Mov Disord Clin Pract 2021; 8:435-444. [PMID: 33816674 DOI: 10.1002/mdc3.13173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/19/2021] [Accepted: 01/30/2021] [Indexed: 12/26/2022] Open
Abstract
Background Palatal tremor (PT) is an uncommon movement disorder that may be classified into symptomatic (SPT) or essential (EPT). The etiology of SPT is varied, with involvement of the Guillain-Mollaret triangle (GMT) and inferior olivary hypertrophy. EPT is associated with ear clicks and normal imaging and may have a functional basis. Objectives This study aims to explore the clinical and radiological features of a large cohort of patients with PT. Methods This is a retrospective chart review of patients with PT who were evaluated by the movement disorders subspeciality of the neurology department. Demographic, clinical, and imaging details of patients with PT were documented. Results A total of 22 patients with PT comprising 17 with SPT and 5 with EPT were included in this study. No patient was aware of the PT. Ear clicks were reported in 2 patients with SPT and in 3 patients with EPT. The most common etiology for SPT was vascular, followed by degenerative conditions. Patients with SPT had associated features such as tremor (70.6%), ataxia (64.7%), dystonia (52.9%), myoclonus (17.6%), and eye movement abnormalities (75%). Lesions involving the GMT were found in 82% of patients with SPT. Apart from PT, patients with EPT had no other motor symptoms, and imaging was normal. Of the patients with EPT, 2 had additional functional movement disorders. Conclusion PT has significant etiological heterogeneity and can be easily missed because of the lack of awareness by patients. Involvement of the inferior olivary nucleus may not be necessarily observed. A functional etiology should be considered in cases of EPT.
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Affiliation(s)
| | - Shweta Prasad
- Department of Neurology National Institute of Mental Health & Neurosciences Bengaluru India.,Department of Clinical Neurosciences National Institute of Mental Health & Neurosciences Bengaluru India
| | - Vikram V Holla
- Department of Neurology National Institute of Mental Health & Neurosciences Bengaluru India
| | - Koti Neeraja
- Department of Neurology National Institute of Mental Health & Neurosciences Bengaluru India
| | - Nitish Kamble
- Department of Neurology National Institute of Mental Health & Neurosciences Bengaluru India
| | - Manjunath Netravathi
- Department of Neurology National Institute of Mental Health & Neurosciences Bengaluru India
| | - Ravi Yadav
- Department of Neurology National Institute of Mental Health & Neurosciences Bengaluru India
| | - Pramod Kumar Pal
- Department of Neurology National Institute of Mental Health & Neurosciences Bengaluru India
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Holla VV, Surisetti BK, Prasad S, Thota N, Stezin A, Pal PK, Yadav R. SPG46 due to truncating mutations in GBA2: Two cases from India. Parkinsonism Relat Disord 2020; 82:13-15. [PMID: 33227682 DOI: 10.1016/j.parkreldis.2020.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/28/2020] [Revised: 10/16/2020] [Accepted: 11/06/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Vikram V Holla
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Bharath Kumar Surisetti
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Shweta Prasad
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India; Department of Clinical Neurosciences, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Naveen Thota
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Albert Stezin
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India; Department of Clinical Neurosciences, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India.
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Neeraja K, Holla VV, Prasad S, Surisetti BK, Rakesh K, Kamble N, Yadav R, Pal PK. Sialidosis Type I without a Cherry Red Spot- Is There a Genetic Basis? J Mov Disord 2020; 14:65-69. [PMID: 33121223 PMCID: PMC7840231 DOI: 10.14802/jmd.20083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/21/2020] [Indexed: 12/15/2022] Open
Abstract
Sialidosis is an inborn error of metabolism due to a defect in the NEU1 gene and manifests as two phenotypes: mild type I and severe type II. The cherry red spot (CRS) is a characteristic feature in both types of sialidosis; reports of sialidosis without a CRS are rare. We report two cases of genetically confirmed sialidosis type I with a typical presentation of progressive cortical myoclonus and ataxia but without the CRS. A previously reported homozygous pathogenic variant p.Arg294Cys was detected in the first case, and a novel homozygous pathogenic variant p.Arg305Pro was detected in the second case. Additionally, we reviewed the literature describing cases with similar mutations to find a genetic basis for the absence of a CRS. Milder mutation of both alleles detected in both patients may be the reason for the absence of a CRS.
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Affiliation(s)
- Koti Neeraja
- Department of Neurology, National Institute of Mental Health and Neurosciences, Karnataka, India
| | - Vikram Venkappayya Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Karnataka, India
| | - Shweta Prasad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Karnataka, India.,Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Karnataka, India
| | - Bharath Kumar Surisetti
- Department of Neurology, National Institute of Mental Health and Neurosciences, Karnataka, India
| | - Kempaiah Rakesh
- Department of Neurology, National Institute of Mental Health and Neurosciences, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health and Neurosciences, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Karnataka, India
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Prasad S, Holla VV, Neeraja K, Surisetti BK, Kamble N, Yadav R, Pal PK. Impact of Prolonged Lockdown due to COVID-19 in Patients with Parkinson's Disease. Neurol India 2020; 68:792-795. [PMID: 32859814 DOI: 10.4103/0028-3886.293472] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The COVID-19 pandemic has compelled countries to impose lockdowns to curb the spread. As a result of the lockdown and need for health care services to cater to acute diseases on priority, patients with chronic illnesses such as Parkinson's disease (PD) may be facing several difficulties. Aims This study aimed to explore the effects of prolongation of lockdown on patients with PD by evaluating possible problems faced during a lockdown and worsening of symptoms if any. Materials and Methods One hundred patients with PD and their caregivers were contacted. Results We observed a significant increase in problems faced due to this pandemic, specifically, the inability to access health care, and difficulty procuring medication. Patients also reported worsening of motor symptoms. Conclusions The present findings highlight the need for health care systems to consider a plan of action for chronic neurological diseases like PD, which are worsening in the absence of regular hospital visits.
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Affiliation(s)
- Shweta Prasad
- Department of Clinical Neurosciences; Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vikram Venkappayya Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Koti Neeraja
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Bharath Kumar Surisetti
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Holla VV, Neeraja K, Surisetti BK, Prasad S, Kamble N, Srinivas D, Yadav R, Pal PK. Deep Brain Stimulation Battery Exhaustion during the COVID-19 Pandemic: Crisis within a Crisis. J Mov Disord 2020; 13:218-222. [PMID: 32854480 PMCID: PMC7502301 DOI: 10.14802/jmd.20073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/05/2020] [Indexed: 12/13/2022] Open
Abstract
Objective The novel coronavirus disease (COVID-19) pandemic and public health measures to control it have resulted in unique challenges in the management of patients with deep brain stimulation (DBS). We report our experience with the management of acute worsening of symptoms due to battery exhaustion in 3 patients with DBS. Methods Patients with DBS for movement disorders who visited the emergency room due to battery exhaustion during the nationwide lockdown from April to May 2020 were included. Results Two patients with subthalamic nucleus-DBS for Parkinson’s disease (PD) and one with globus pallidus interna-DBS for generalized dystonia presented with acute worsening of symptoms due to battery exhaustion. Urgent battery replacement was performed in both patients with PD. The patient with generalized dystonia was managed with medication adjustment as he chose to defer battery replacement. Conclusion DBS battery replacement can be an emergency. Decisions regarding DBS battery replacement should be individualized during this COVID-19 pandemic.
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Affiliation(s)
| | - Koti Neeraja
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Bharath Kumar Surisetti
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Shweta Prasad
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India.,Department of Clinical Neurosciences, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
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Prasad S, Holla VV, Neeraja K, Surisetti BK, Kamble N, Yadav R, Pal PK. Parkinson's Disease and COVID-19: Perceptions and Implications in Patients and Caregivers. Mov Disord 2020; 35:912-914. [PMID: 32304118 PMCID: PMC7264599 DOI: 10.1002/mds.28088] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 12/31/2022] Open
Affiliation(s)
- Shweta Prasad
- Department of Clinical Neurosciences, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India.,Department of Neurology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Vikram Venkappayya Holla
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Koti Neeraja
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Bharath Kumar Surisetti
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
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