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Mondal B, Choudhury S, Banerjee R, Roy A, Chatterjee K, Basu P, Singh R, Halder S, Shubham S, Baker SN, Baker MR, Kumar H. Effects of non-invasive vagus nerve stimulation on clinical symptoms and molecular biomarkers in Parkinson's disease. Front Aging Neurosci 2024; 15:1331575. [PMID: 38384731 PMCID: PMC10879328 DOI: 10.3389/fnagi.2023.1331575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/20/2023] [Indexed: 02/23/2024] Open
Abstract
Non-invasive vagus nerve stimulation (nVNS) is an established neurostimulation therapy used in the treatment of epilepsy, migraine and cluster headache. In this randomized, double-blind, sham-controlled trial we explored the role of nVNS in the treatment of gait and other motor symptoms in Parkinson's disease (PD) patients. In a subgroup of patients, we measured selected neurotrophins, inflammatory markers and markers of oxidative stress in serum. Thirty-three PD patients with freezing of gait (FOG) were randomized to either active nVNS or sham nVNS. After baseline assessments, patients were instructed to deliver six 2 min stimulations (12 min/day) of the active nVNS/sham nVNS device for 1 month at home. Patients were then re-assessed. After a one-month washout period, they were allocated to the alternate treatment arm and the same process was followed. Significant improvements in key gait parameters (speed, stance time and step length) were observed with active nVNS. While serum tumor necrosis factor- α decreased, glutathione and brain-derived neurotrophic factor levels increased significantly (p < 0.05) after active nVNS treatment. Here we present the first evidence of the efficacy and safety of nVNS in the treatment of gait in PD patients, and propose that nVNS can be used as an adjunctive therapy in the management of PD patients, especially those suffering from FOG. Clinical trial registration: identifier ISRCTN14797144.
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Affiliation(s)
| | | | | | - Akash Roy
- Institute of Neurosciences Kolkata, Kolkata, India
| | | | - Purba Basu
- Institute of Neurosciences Kolkata, Kolkata, India
| | - Ravi Singh
- Institute of Neurosciences Kolkata, Kolkata, India
| | | | | | - Stuart N. Baker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mark R. Baker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
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Upadhyay J, Soni S, Shubham S, Kumar S, Singh P, Basu S. Pain Assessment and Management Practices via Education & Reinforcement (PAMPER): A Quality Improvement Initiative. Indian J Pediatr 2023:10.1007/s12098-023-04863-8. [PMID: 37817029 DOI: 10.1007/s12098-023-04863-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/31/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVES To establish neonatal pain management practices as an essential developmental supportive measure at a tertiary care unit. METHODS This quality improvement initiative was conducted as per Point-of-Care-Quality-Improvement Model over 6 mo, followed by 2 y of sustenance phase at a Neonatal Intensive Care Unit (NICU) in northern India. Infants of birth weight ≤1800 g were included and assessed for pain. Pain Assessment and Management Practices via Education and Reinforcement (PAMPER) group was created by resident doctors and nursing staff. The Premature Infant Pain Profile score was used for the assessment of pain. Limiting factors were analyzed using a fishbone diagram and interventions were done in multiple Plan-Do-Study-Act cycles. RESULTS At the end of interventions, 100% of procedures were assessed for pain. The mean (standard deviation) documented pain score for the first seven days was reduced from 12.8 (0.3) in the baseline phase to 7 (2.5). These interventions helped to sustain the practice in >70% of infants in the next 2 y. CONCLUSIONS Low-cost interventions improved the pain assessment and management policy of authors' NICU with the establishment of a standard protocol. Audits and reinforcement at regular intervals helped in its long-term sustenance.
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Affiliation(s)
- Jaya Upadhyay
- Department of Neonatology, SSH, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, 482003, India.
| | - Shishir Soni
- Department of Cardiology, SSH, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Shantanu Shubham
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sourabh Kumar
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Poonam Singh
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Grover R, Singh P, Shubham S, Priyadarshi M, Chaurasia S, Basu S. Delivery Room Respiratory Stabilization of Preterm Neonates: A Randomized, Controlled Trial. Indian J Pediatr 2022; 89:793-800. [PMID: 35397090 DOI: 10.1007/s12098-022-04124-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/12/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine whether heated humidified high-flow nasal cannula (HHHFNC) is noninferior to NCPAP to provide DR respiratory support to preterm neonates of gestational age (GA) 28-36 wk. METHODS This randomized, controlled, noninferiority trial included 124 spontaneously breathing preterm neonates who developed respiratory distress soon after birth and/or had a FiO2 requirement > 0.3. Primary outcome measure was treatment failure within 24 h. The absolute risk difference with 95% confidence interval (CI) were calculated with a noninferiority margin of 10%. Secondary outcome variables were temperature at admission, time to treatment failure, treatment failure at 72 h, need for surfactant, intubation, duration of respiratory support, and incidences of adverse events including mortality. Intention-to-treat analysis was done in Stata software. RESULTS Both the groups were similar in baseline characteristics. There was no statistically significant difference between the treatment failure rates with HHHFNC (13.1%, n = 61) and NCPAP (11.1%, n = 63) (risk difference 2.0%, 95% CI - 9.9% to 14.07%, p = 0.73). However, noninferiority of HHHFNC to NCPAP could not be conclusively proved as the 95% CI crossed both 0 and the noninferiority margin of 10%. There were no significant differences in secondary outcomes. CONCLUSIONS HHHFNC showed similar efficacy and safety as NCPAP irrespective of gestational age, though its noninferiority to NCPAP remained inconclusive. TRIAL REGISTRATION Clinical Trial Registry of India, Registration no: CTRI/2019/10/021633, https://ctri.icmr.org.in/.
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Affiliation(s)
- Rajat Grover
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Poonam Singh
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Shantanu Shubham
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Mayank Priyadarshi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Suman Chaurasia
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
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Fearon C, Rawal S, Olszewska D, Alcaide‐Leon P, Kern DS, Sharma S, Jaiswal SK, Murthy JM, Ha AD, Schwartz RS, Fung VS, Spears C, Tholanikunnel T, Almeida L, Hatano T, Oji Y, Hattori N, Shubham S, Kumar H, Bhidayasiri R, Laohathai C, Lang AE. Neuroimaging Pearls from the MDS Congress Video Challenge. Part 2: Acquired Disorders. Mov Disord Clin Pract 2022; 9:311-325. [PMID: 35402651 PMCID: PMC8974867 DOI: 10.1002/mdc3.13415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 02/05/2023] Open
Abstract
The MDS Video Challenge continues to be the one of most widely attended sessions at the International Congress. Although the primary focus of this event is the presentation of complex and challenging cases through videos, a number of cases over the years have also presented an unusual or important neuroimaging finding related to the case. We reviewed the previous Video Challenge cases and present here a selection of those cases which incorporated such imaging findings. We have compiled these "imaging pearls" into two anthologies. The first focuses on pearls where the underlying diagnosis was a genetic condition. This second anthology focuses on imaging pearls in cases where the underlying condition was acquired. For each case we present brief clinical details along with neuroimaging findings, the characteristic imaging findings of that disorder and, finally, the differential diagnosis for the imaging findings seen.
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Affiliation(s)
- 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
| | - Sapna Rawal
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western HospitalUniversity Health NetworkTorontoOntarioCanada
| | - Diana 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
| | - Paula Alcaide‐Leon
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western HospitalUniversity Health NetworkTorontoOntarioCanada
| | - Drew S. Kern
- Department of Neurology and NeurosurgeryUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Soumya Sharma
- Department of Clinical Neurological Sciences, London Health Sciences CentreWestern UniversityLondonOntarioCanada
| | | | | | - Ainhi D. Ha
- Movement Disorders UnitWestmead HospitalWestmeadNew South WalesAustralia
| | - Raymond S. Schwartz
- Southern NeurologyKoharahNew South WalesAustralia,Sydney Medical SchoolThe University of SydneyCamperdownNew South WalesAustralia
| | - Victor S.C. Fung
- Movement Disorders UnitWestmead HospitalWestmeadNew South WalesAustralia,Sydney Medical SchoolThe University of SydneyCamperdownNew South WalesAustralia
| | - Chauncey Spears
- Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
| | - Tracy Tholanikunnel
- Department of Neurology, Normal Fixel Institute for Neurological DiseasesUniversity of FloridaGainesvilleFloridaUSA
| | - Leonardo Almeida
- Department of Neurology, Normal Fixel Institute for Neurological DiseasesUniversity of FloridaGainesvilleFloridaUSA
| | - Taku Hatano
- Department of Neurology, Faculty of Medicine, Juntendo UniversityTokyoJapan
| | - Yutaka Oji
- Department of Neurology, Faculty of Medicine, Juntendo UniversityTokyoJapan
| | - Nobutaka Hattori
- Department of Neurology, Faculty of Medicine, Juntendo UniversityTokyoJapan
| | | | | | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross SocietyBangkokThailand,The Academy of Science, The Royal Society of ThailandBangkokThailand
| | | | - 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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Shubham S, Naseeruddin S, Rekha US, Priyadarshi M, Gupta P, Basu S. Wickerhamomyces anomalus: A Rare Fungal Sepsis in Neonates. Indian J Pediatr 2021; 88:838. [PMID: 34018136 DOI: 10.1007/s12098-021-03783-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Shantanu Shubham
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Shaik Naseeruddin
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - U Sasi Rekha
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mayank Priyadarshi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
| | - Pratima Gupta
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
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Upadhyay J, Basu S, Srivastava Y, Digal KC, Shubham S, Grover R, Singh P. Agitated saline contrast to delineate central venous catheter position in neonates. J Perinatol 2021; 41:1638-1644. [PMID: 32728038 DOI: 10.1038/s41372-020-0761-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/11/2020] [Accepted: 07/22/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Central venous catheter (CVC) insertion is required for the management of sick neonates. Ultrasonography/targeted neonatal echocardiography (TNE) with/without normal saline (NS) flush is used to identify CVC position. The present study compared the visibility and safety of agitated saline (AS) with normal saline (NS) flush. STUDY DESIGN This prospective interventional study included 110 CVC insertions, both umbilical venous catheterization (UVC) and peripherally inserted central catheterization (PICC). Catheter position was monitored by real-time TNE. RESULTS Overall visibility of catheter tip (combined UVC and PICC) was significantly better in AS (n = 55) compared with NS group (n = 55) [48/55 (87.2%) vs. 28/55 (50.9%); p < 0.0001]. Time to detect catheter tip by AS push was significantly less than that of NS push. There was no difference in the amount of saline flush required with either method. No major adverse effect was observed. CONCLUSIONS AS push can be used as a safe method to delineate CVC position in neonates.
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Affiliation(s)
- Jaya Upadhyay
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, India.
| | - Yash Srivastava
- Division of Cardiology, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India
| | - Kanhu Charan Digal
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, India
| | - Shantanu Shubham
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, India
| | - Rajat Grover
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, India
| | - Poonam Singh
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, India
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Mondal B, Choudhury S, Banerjee R, Roy A, Chatterjee K, Basu P, Singh R, Halder S, Shubham S, Baker SN, Baker MR, Kumar H. Non-invasive vagus nerve stimulation improves clinical and molecular biomarkers of Parkinson's disease in patients with freezing of gait. NPJ Parkinsons Dis 2021; 7:46. [PMID: 34045464 PMCID: PMC8160211 DOI: 10.1038/s41531-021-00190-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/21/2021] [Indexed: 12/19/2022]
Abstract
Non-invasive vagus nerve stimulation (nVNS) is an established neurostimulation therapy used in the treatment of epilepsy, migraine and cluster headache. In this randomized, double-blind, sham-controlled crossover trial we explored the role of nVNS in the treatment of gait and other motor symptoms in Parkinson’s disease (PD) patients. In a subgroup of patients, we measured selected neurotrophin levels and markers of inflammation and oxidative stress in serum, before and after the experimental intervention. Thirty-three PD patients with associated freezing of gait were randomised to either nVNS or sham. After baseline assessments, patients were instructed to deliver 6 two-minute stimulations (total 12 min/day) of the nVNS/sham device (electroCore, Inc. USA) for one month at home. Patients were then re-assessed. After a washout period of one month, the same patients were allocated to the alternate treatment arm and the same process was followed. Significant improvements in key gait parameters were observed with nVNS, including walking speed, stance time and step length, compared to sham. Similarly, overall motor function (MDS-UPDRS III) also improved significantly following nVNS stimulation. Serum Tumor Necrosis Factor (TNF)-α and glutathione levels decreased and brain-derived neurotrophic factor (BDNF) levels increased significantly (p < 0.05) after treatment with nVNS. Here we present the first double-blind sham-controlled trial evidence of the efficacy and safety of nVNS in the treatment of gait and motor function in patients with PD.
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Affiliation(s)
| | | | | | - Akash Roy
- Institute of Neurosciences Kolkata, Kolkata, India
| | | | - Purba Basu
- Institute of Neurosciences Kolkata, Kolkata, India
| | - Ravi Singh
- Institute of Neurosciences Kolkata, Kolkata, India
| | | | | | - Stuart N Baker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Mark R Baker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.,Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle, UK
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Grover R, Shubham S, Upadhyay J, Digal KC, Singh P, Basu S. Reduction of Prescription Errors in Neonatal Intensive Care Unit:A Quality Improvement Initiative. Indian J Pediatr 2021; 88:94. [PMID: 32780349 DOI: 10.1007/s12098-020-03470-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Rajat Grover
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Shantanu Shubham
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Jaya Upadhyay
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Kanhu Charan Digal
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Poonam Singh
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
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Choudhury S, Singh R, Shobhana A, Sen D, Anand SS, Shubham S, Gangopadhyay S, Baker MR, Kumar H, Baker SN. A Novel Wearable Device for Motor Recovery of Hand Function in Chronic Stroke Survivors. Neurorehabil Neural Repair 2020; 34:600-608. [PMID: 32452275 PMCID: PMC8207486 DOI: 10.1177/1545968320926162] [Citation(s) in RCA: 8] [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] [Indexed: 11/17/2022]
Abstract
Background. In monkey, reticulospinal connections to hand and forearm muscles are spontaneously strengthened following corticospinal lesions, likely contributing to recovery of function. In healthy humans, pairing auditory clicks with electrical stimulation of a muscle induces plastic changes in motor pathways (probably including the reticulospinal tract), with features reminiscent of spike-timing dependent plasticity. In this study, we tested whether pairing clicks with muscle stimulation could improve hand function in chronic stroke survivors. Methods. Clicks were delivered via a miniature earpiece; transcutaneous electrical stimuli at motor threshold targeted forearm extensor muscles. A wearable electronic device (WD) allowed patients to receive stimulation at home while performing normal daily activities. A total of 95 patients >6 months poststroke were randomized to 3 groups: WD with shock paired 12 ms before click; WD with clicks and shocks delivered independently; standard care. Those allocated to the device used it for at least 4 h/d, every day for 4 weeks. Upper-limb function was assessed at baseline and weeks 2, 4, and 8 using the Action Research Arm Test (ARAT), which has 4 subdomains (Grasp, Grip, Pinch, and Gross). Results. Severity across the 3 groups was comparable at baseline. Only the paired stimulation group showed significant improvement in total ARAT (median baseline: 7.5; week 8: 11.5; P = .019) and the Grasp subscore (median baseline: 1; week 8: 4; P = .004). Conclusion. A wearable device delivering paired clicks and shocks over 4 weeks can produce a small but significant improvement in upper-limb function in stroke survivors.
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Affiliation(s)
| | - Ravi Singh
- Institute of Neurosciences, Kolkata, West Bengal, India
| | - A Shobhana
- Institute of Neurosciences, Kolkata, West Bengal, India
| | - Dwaipayan Sen
- Institute of Neurosciences, Kolkata, West Bengal, India
| | | | | | | | - Mark R Baker
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK.,Royal Victoria Infirmary, Newcastle upon Tyne, Tyne and Wear, UK
| | | | - Stuart N Baker
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
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Chatterjee K, Roy A, Banerjee R, Choudhury S, Mondal B, Halder S, Basu P, Shubham S, Dey S, Kumar H. Inflammasome and α-synuclein in Parkinson's disease: A cross-sectional study. J Neuroimmunol 2019; 338:577089. [PMID: 31704453 DOI: 10.1016/j.jneuroim.2019.577089] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [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: 04/24/2019] [Revised: 10/03/2019] [Accepted: 10/17/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Alpha-synuclein and inflammatory pathology are evident in Parkinson's disease (PD) but, their link to disease pathogenesis needs further elucidation. OBJECTIVES To explore α-synuclein-mediated inflammation in the serum of PD patients and its link with disease severity. METHODS Serum levels of IL-1β, NLRP3, total and phosphorylated α-synuclein were compared. RESULTS IL-1β, NLRP3 levels were significantly increased in PD. We also observed a linear correlation of NLRP3 with α-synuclein. Phosphorylated α-synuclein levels were significantly elevated in later stages of PD. CONCLUSIONS The α-synuclein-NLRP3 mediated inflammation may underline the pathophysiology of PD and might serve as a novel therapeutic target in PD.
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Affiliation(s)
- Koustav Chatterjee
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, India
| | - Akash Roy
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, India; Department of Physiology, University of Calcutta, Kolkata, India
| | - Rebecca Banerjee
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, India
| | - Supriyo Choudhury
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, India
| | - Banashree Mondal
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, India
| | - Saptak Halder
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, India
| | - Purba Basu
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, India
| | - Shantanu Shubham
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, India
| | - Sanjit Dey
- Department of Physiology, University of Calcutta, Kolkata, India; Centre with Potential for Excellence in Particular Area (CPEPA), University of Calcutta, Kolkata, India
| | - Hrishikesh Kumar
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, India.
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Choudhury S, Shobhana A, Singh R, Sen D, Anand SS, Shubham S, Baker MR, Kumar H, Baker SN. The Relationship Between Enhanced Reticulospinal Outflow and Upper Limb Function in Chronic Stroke Patients. Neurorehabil Neural Repair 2019; 33:375-383. [DOI: 10.1177/1545968319836233] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background. Recent evidence from both monkey and human studies suggests that the reticulospinal tract may contribute to recovery of arm and hand function after stroke. In this study, we evaluated a marker of reticulospinal output in stroke survivors with varying degrees of motor recovery. Methods. We recruited 95 consecutive stroke patients presenting 6 months to 12 years after their index stroke, and 19 heathy control subjects. Subjects were asked to respond to a light flash with a rapid wrist flexion; at random, the flash was paired with either a quiet or loud (startling) sound. The mean difference in electromyogram response time after flash with quiet sound compared with flash with loud sound measured the StartReact effect. Upper limb function was assessed by the Action Research Arm Test (ARAT), spasticity was graded using the Modified Ashworth Scale (MAS) and active wrist angular movement using an electrogoniometer. Results. StartReact was significantly larger in stroke patients than healthy participants (78.4 vs 45.0 ms, P < .005). StartReact showed a significant negative correlation with the ARAT score and degree of active wrist movement. The StartReact effect was significantly larger in patients with higher spasticity scores. Conclusion. We speculate that in some patients with severe damage to their corticospinal tract, recovery led to strengthening of reticulospinal connections and an enhanced StartReact effect, but this did not occur for patients with milder impairment who could use surviving corticospinal connections to mediate recovery.
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Affiliation(s)
| | | | - Ravi Singh
- Institute of Neurosciences, Kolkata, India
| | | | | | | | - Mark R. Baker
- Department of Clinical Neurophysiology and Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | | | - Stuart N. Baker
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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Ghosh M, Shubham S, Mandal K, Trivedi V, Chauhan R, Naseera S. Survival and prognostic factors for glioblastoma multiforme: Retrospective single-institutional study. Indian J Cancer 2018; 54:362-367. [PMID: 29199724 DOI: 10.4103/ijc.ijc_157_17] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Glioblastoma multiforme (GBM) is the most common and aggressive primary brain tumor in adults. The standard management has been maximum surgical resection followed by adjuvant radiotherapy with concurrent chemotherapy followed by adjuvant chemotherapy. Although the survival rate of patients with GBM has improved with recent advancements in treatment, the prognosis remains generally poor. The median survival rates are in the range of 9-12 months and 2-year survival rates are in the range of 8%-12%. MATERIALS AND METHODS A single-institution retrospective review of 61 patients of GBM from 2012 to 2014. Data regarding patient factors, disease factors, and treatment factors were collected and survival has been calculated. RESULTS A total of 61 patients with GBM were analyzed. GBM is commonly seen in sixth decade of life. Male to female ratio is 2.6:1. The right side of the brain is commonly involved with right frontal lobe being the most common site. The median follow-up was 4.6 months. The median survival of our patients was 8 months. The 1-year and 2-year survival rates were 20% and 3.27%, respectively. CONCLUSIONS The overall survival and prognosis in patients with GBM remains poor despite of constant research and studies. Concurrent chemoradiotherapy followed by adjuvant chemotherapy with temozolomide should be used after maximal resection to improve the survival.
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Affiliation(s)
- M Ghosh
- Department of Radiation Oncology, Mahavir Cancer Sansthan, Patna, Bihar, India
| | - S Shubham
- Department of Radiation Oncology, Mahavir Cancer Sansthan, Patna, Bihar, India
| | - K Mandal
- Department of Radiation Oncology, Mahavir Cancer Sansthan, Patna, Bihar, India
| | - V Trivedi
- Department of Radiation Oncology, Mahavir Cancer Sansthan, Patna, Bihar, India
| | - R Chauhan
- Department of Radiation Oncology, Mahavir Cancer Sansthan, Patna, Bihar, India
| | - S Naseera
- Department of Radiation Oncology, Mahavir Cancer Sansthan, Patna, Bihar, India
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Choudhury S, Singh R, Chatterjee P, Trivedi S, Shubham S, Baker MR, Kumar H, Baker SN. Abnormal Blink Reflex and Intermuscular Coherence in Writer's Cramp. Front Neurol 2018; 9:517. [PMID: 30013510 PMCID: PMC6037196 DOI: 10.3389/fneur.2018.00517] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/11/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Writer's cramp (WC) is a task-specific focal hand dystonia presenting with pain, stiffness and/or tremor while writing. We explored the involvement of cortical and brainstem circuits by measuring intermuscular coherence (IMC) and pre-pulse inhibition (PPI) of the blink reflex. Methods: IMC was measured in 10 healthy controls and 20 WC patients (10 with associated tremor) while they performed a precision grip task at different force levels. Blink responses were evaluated in 9 healthy controls and 10 WC patients by stimulating the right supraorbital nerve and recording surface EMG from the orbicularis oculi muscles bilaterally. PPI involved conditioning this stimulation with a prior shock to the right median nerve (100 ms interval), and measuring the reduction in the R2 component of the blink reflex. Results: Significant IMC at 3-7 Hz was present in WC patients, but not in healthy controls. Compared to healthy controls, in WC patients the R2 component of the blink reflex showed significantly less PPI. IMC at 3-7 Hz could reliably discriminate WC patients from healthy controls. Conclusion: Cortical or sub-cortical circuits generating theta (3-7 Hz) oscillations might play an important role in the pathogenesis of WC. Moreover, the lack of PPI implicates abnormalities in brainstem inhibition in the emergence of WC. IMC may merit further development as an electrodiagnostic test for focal dystonia.
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Affiliation(s)
- Supriyo Choudhury
- Department of Neurology, Ram Gopal Chamaria Research Center, Institute of Neurosciences, Kolkata, India
| | - Ravi Singh
- Department of Neurology, Ram Gopal Chamaria Research Center, Institute of Neurosciences, Kolkata, India
| | - Payel Chatterjee
- Department of Neurology, Ram Gopal Chamaria Research Center, Institute of Neurosciences, Kolkata, India
| | - Santosh Trivedi
- Department of Neurology, Ram Gopal Chamaria Research Center, Institute of Neurosciences, Kolkata, India
| | - Shantanu Shubham
- Department of Neurology, Ram Gopal Chamaria Research Center, Institute of Neurosciences, Kolkata, India
| | - Mark R. Baker
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Institute of Neurosciences, The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Hrishikesh Kumar
- Department of Neurology, Ram Gopal Chamaria Research Center, Institute of Neurosciences, Kolkata, India
| | - Stuart N. Baker
- Institute of Neurosciences, The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
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Chatterjee K, Choudhury S, Shubham S, Mondal B, Basu P, Kumar H. Siblings with unusual presentation of early onset Parkinson's disease with dual heterozygous PARK2 and PARK 9 mutation. Parkinsonism Relat Disord 2018; 52:117-118. [PMID: 29606608 DOI: 10.1016/j.parkreldis.2018.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/17/2017] [Revised: 03/04/2018] [Accepted: 03/17/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Koustav Chatterjee
- Department of Neurology and RGCM Research Centre, Institute of Neurosciences, Kolkata, India.
| | - Supriyo Choudhury
- Department of Neurology and RGCM Research Centre, Institute of Neurosciences, Kolkata, India.
| | - Shantanu Shubham
- Department of Neurology and RGCM Research Centre, Institute of Neurosciences, Kolkata, India.
| | - Banashree Mondal
- Department of Neurology and RGCM Research Centre, Institute of Neurosciences, Kolkata, India.
| | - Purba Basu
- Department of Neurology and RGCM Research Centre, Institute of Neurosciences, Kolkata, India.
| | - Hrishikesh Kumar
- Department of Neurology and RGCM Research Centre, Institute of Neurosciences, Kolkata, India.
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Choudhury S, Chatterjee S, Chatterjee K, Banerjee R, Humby J, Mondal B, Anand SS, Shubham S, Kumar H. Clinical Characterization of Genetically Diagnosed Cases of Spinocerebellar Ataxia Type 12 from India. Mov Disord Clin Pract 2018; 5:39-46. [PMID: 30363072 PMCID: PMC6090588 DOI: 10.1002/mdc3.12551] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 08/14/2017] [Accepted: 09/02/2017] [Indexed: 12/14/2022] Open
Abstract
https://onlinelibrary.wiley.com/page/journal/23301619/homepage/mdc312551-sup-v001_1.htm. BACKGROUND Spinocerebellar ataxia type 12 (SCA12) is a rare form of an autosomal-dominant ataxic disorder associated with an expansion of CAG repeat length. Here, we present a large case series of patients with SCA12 and describe a wide range of typical and rare symptoms. METHODS Twenty-one consecutive patients with genetically proven SCA12 underwent detailed neurological examination. We assessed clinical characteristics using validated rating scales for evaluating motor features in SCA. Nonmotor symptoms and quality of life were assessed using appropriate, validated scales. Correlations of CAG repeat length with both severity score and age of onset were explored. RESULTS The mean age of onset was 51 years, and most patients were descendants of a single, endogamous Indian community (Agarwal). Tremor was the most common initial presenting symptom (90%). Hand dystonia was present in 14 of 21 patients, and most patients in the cohort presented with gait disturbance. Neuropsychiatric manifestations were common coexisting features. The CAG repeat length was significantly correlated (r = -0.760; P = 0.0001) with early age of onset, but not with disease severity. Tremor affected the quality of life in 18 of 21 patients, because they had difficulty in handling liquids. CONCLUSIONS Tremor was the most common, nonataxic symptom at initial presentation in patients with SCA12. Proximal upper limb tremor, typically with high amplitude and low frequency, can raise a strong diagnostic suspicion. Associated hand dystonia was a common coexisting motor feature. Various nonmotor features were also observed in several cases which require therapeutic attention.
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Affiliation(s)
| | | | | | | | - Jonathan Humby
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUnited Kingdom
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Mondal B, Choudhury S, Chatterjee K, Banerjee R, Shubham S, Baker M, Kumar H. Therapeutic effect of non-invasive vagus nerve stimulation in gait disturbance and freezing in Parkinson’s disease patients. Parkinsonism Relat Disord 2018. [DOI: 10.1016/j.parkreldis.2017.11.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Choudhury S, Chatterjee K, Singh R, Shubham S, Trivedi S, Chatterjee S, Kumar H. Levosulpiride-induced Movement Disorders. J Pharmacol Pharmacother 2017; 8:177-181. [PMID: 29472751 PMCID: PMC5820749 DOI: 10.4103/jpp.jpp_32_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/13/2017] [Accepted: 07/10/2017] [Indexed: 11/04/2022] Open
Abstract
We reported a series of patients who presented with LSP-induced movement disorders specifically, dyskinetic movements. We have presented one case of LSP-induced parkinsonism and summarized ten cases of LSP-induced dyskinesia. The causality of the adverse drug reaction was assessed systematically using a validated rating system, and we extensively qualified the clinical presentation of each case of dyskinesia using a clinical rating scale. We described an unusual case of acute onset LSP-induced parkinsonism in a 56-year-aged female. The mean age of ten patients of LSP-induced dyskinesia was 65.3 years (standard deviation 10.4), and 25% of patients were female. They were consuming suspected medication for a median duration of 13 months (range 1-60 months). We noted LSP-induced dyskinesia was challenging to treat as its resolution is often incomplete even with adequate treatment.
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Affiliation(s)
- Supriyo Choudhury
- Department of Neurology, RGC Research Centre, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Koustav Chatterjee
- Department of Neurology, RGC Research Centre, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Ravi Singh
- Department of Neurology, RGC Research Centre, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Shantanu Shubham
- Department of Neurology, RGC Research Centre, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Santosh Trivedi
- Department of Neurology, RGC Research Centre, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Suparna Chatterjee
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Hrishikesh Kumar
- Department of Neurology, RGC Research Centre, Institute of Neurosciences, Kolkata, West Bengal, India
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Mondal B, Choudhury S, Banerjee R, Chatterjee P, Kulsum MU, Chatterjee S, Chatterjee K, Sen S, Ghoshal A, Shubham S, Naskar D, Anand SS, Kumar H. Gait analysis in Parkinson’s disease assessing the effect of levodopa using a validated electronic walkway. Parkinsonism Relat Disord 2016. [DOI: 10.1016/j.parkreldis.2015.10.185] [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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