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2020| September-October | Volume 23 | Issue 5
Online since
December 8, 2020
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Teleneurorehabilitation for Parkinson's Disease: A Panacea for the Times to Come?
Divyani Garg, Rajinder K Dhamija
September-October 2020, 23(5):592-597
DOI
:10.4103/aian.AIAN_566_20
Telemedicine is witnessing a rebirth due to the COVID-19 pandemic and the continuing need for limited-contact or contactless care in medicine. Telerehabilitation, an offshoot of telemedicine, is a valuable yet underexplored tool in the therapeutic armamentarium of patients with neurological conditions, particularly Parkinson’s disease (PD). Although there is evidence in literature reporting the use of telerehabilitation and virtual reality-based services in providing rehabilitation to improve speech, swallowing, gait, and postural instability among persons with PD, the evidence is limited due to small patient numbers. Teleneurorehabilitation (TNR) is an underutilized strategy that may be as effective and perhaps more feasible and affordable among Indian PD patients and also allows sustained rehabilitation. In this article, we encapsulate the evidence on the utility and efficacy of TNR among persons with PD and call upon the neurology community to recognize and utilize the valuable asset that TNR may be for PD patients.
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2
CASE REPORTS
Selective hand motor cortex lesions masquerading as “Pseudoperipheral Nerve Palsy”
Bhaskara P Shelley, Prakash Harishchandra, Acharya K Devadas
September-October 2020, 23(5):688-693
DOI
:10.4103/aian.AIAN_9_19
Strategic cortical lesions involving the hand motor cortex (HMC) presenting acutely as distal upper limb pure motor weakness certainly do need to be differentiated on clinical grounds from “pseudoperipheral palsy.” This rare phenotype can imitate peripheral motor nerve deficits and should not be easily overlooked. The? isolated “central hand and finger weakness” presenting as an acute onset of varying combinations such as pseudomedian, pseudoradial, and/or pseudoulnar nerve palsy is intriguing to the novice. In literature, this phenotype has been reported solely to result from cortical cerebral infarction and documented to occur in <1% of all ischemic strokes. The apropos of six “unforgettable patients” here highlights the heterogeneous pathophysiologic etiologies and mechanisms that included not only the conventional stroke risk factors but also hyperhomocysteinemia, common carotid artery thrombosis due to hyperhomocysteinemia and severe iron-deficiency anemia, biopsy-proven giant cell arteritis (GCA), cerebral metastasis, and dilated cardiomyopathy-related left ventricular thrombosis. Physicians and neurologists alike, as clinicians, need to be familiar with the peculiarities and clinical presentations of central hand control network cortical lesions.
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ORIGINAL ARTICLES
Systematic development of structured semi-interactive stroke prevention package for secondary stroke prevention
Mahesh Pundlik Kate, Shweta Jain Verma, Deepti Arora, PN Sylaja, MV Padma, Rohit Bhatia, Dheeraj Khurana, Arvind Sharma, Pawan Kumar Ojha, Vishnu Renjith, Girish Baburao Kulkarni, Mohammad Sadiq, S Jabeen, NC Borah, Biman Kanti Ray, Meenakshi Sharma, Jeyaraj Durai Pandian
September-October 2020, 23(5):681-686
DOI
:10.4103/aian.AIAN_639_19
Background:
Lack of compliance to medication and uncontrolled risk factors are associated with increased risk of recurrent stroke and acute coronary syndrome in patients with recent stroke. Multimodal patient education may be a strategy to improve the compliance to medication and early adoption of nonpharmacological measures to reduce the vascular risk factor burden in patients with stroke. We thus aim to develop multilingual short messaging services (SMS), print, and audio-visual secondary stroke prevention patient education package. The efficacy of the package will be tested in a randomized control trial to prevent major cardiovascular and cerebrovascular events.
Methods:
In the
formative
stage, intervention materials (SMS, video, and workbook) were developed. In the
acceptability
stage, the package was independently assessed and modified by the stakeholders involved in the stroke patient care and local language experts. The modified stroke prevention package was tested for implementation issues (
implementation
stage).
Results:
Sixty-nine SMS, six videos, and workbook with 11 chapters with 15 activities were developed in English language with a mean ± SD SMOG index of 9.1 ± 0.4. A total of 355 stakeholders including patients (24.8%), caregivers (24.8%), doctors (10.4%), nurses (14.1%), local language experts (2.8%), physiotherapists (13.2%), and research coordinators (9.8%) participated in 10 acceptability stage meetings. The mean Patient Education Material Assessment Tool understandability score in all languages for SMS, video scripts, and workbook was 95.2 ± 2.6%, 95.2 ± 4.4%, and 95.3 ± 3.6%, respectively. The patients [
n
= 20, mean age of 70.3 ± 10.6 years and median interquartile range (IQR) baseline NIHSS 1 (0–3)] or the research coordinators (
n
= 2) noted no implementation issues at the end of 1 month.
Conclusion:
An implementable complex multilingual patient education material could be developed in a stepwise manner. The efficacy of the package to prevent major adverse cardiovascular events is being tested in the SPRINT INDIA study.
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CASE REPORTS
A rare cause of autism spectrum disorder: Megaconial muscular dystrophy
Gultekin Kutluk, Naz Kadem, Omer Bektas, Hatice Nur Eroglu
September-October 2020, 23(5):694-696
DOI
:10.4103/aian.AIAN_98_19
Megaconial congenital muscular dystrophy (OMIM 602541) is defined by early-onset hypotonia, mildly elevated serum creatine kinase (CK) levels, muscle wasting, cardiomyopathy, psychomotor developmental delay and intellectual disability. The disease is caused by loss-of-function mutations in Choline kinase beta gene (CHKB) and has specific muscle biopsy findings. Here we investigate two patients with weakness of proximal muscles and generalized muscle atrophy, skin changes, agressiveness, social communication and empathy difficulties. Both patients had mildly elevated serum CK levels. Whole exome sequencing (WES) performed for both patients and homozygous c.818+1G>A and homozygous c.1031+1G>A variants were detected in patient 1 and patient 2, respectively. We would like to draw the attention of autism spectrum disorder in early diagnosis of congenital muscular dystrophies.
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3,777
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Identification of a novel mutation in
GRIN2A
gene with global developmental delay and refractory epilepsy
Esra Sarigecili, Meltem Cobanogullari Direk, Mustafa Komur, Sevcan Tug Bozdogan, Cetin Okuyaz
September-October 2020, 23(5):696-699
DOI
:10.4103/aian.AIAN_365_18
We report a 2.5-year-old Turkish boy who first presented with nystagmus, lack of eye contact, and hypotonia at 2 months of age and developed refractory seizures when 6 months old. Extensive metabolic tests and imaging being noncontributory, whole-exome sequencing was carried out which revealed a heterozygote
NM_001134407.2:C.3299A>G (p.Glu1100Gly)
novel mutation in
GRIN2A
gene. Topiramate was started and seizures were rapidly brought under control.
GRIN2A
mutations may result in altered GluN2A membrane trafficking and response to glutamate. This report illustrates the clinical variability of
GRIN2A
mutations according to the age of onset of symptoms and suggests considering mutations in this gene in cases of global developmental delay, refractory epilepsy, and nystagmus.
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ORIGINAL ARTICLES
Role of High Frequency Ultrasound in Diagnosing Carpal Tunnel Syndrome as Compared with Conventional Nerve Conduction Studies
Monika Singla, Mukesh K Sharma, Dheraj Khurana, Vivek Lal
September-October 2020, 23(5):649-655
DOI
:10.4103/aian.AIAN_469_19
Objective:
Our aim was to evaluate High Frequency Ultrasonography as a tool for diagnosis in patients withcarpal tunnel syndrome in comparison with electrophysiological study.
Methods:
Thirty- one patients [56 hands] with CTS and twenty-five asymptomatic controls [50 hands] were assessed and underwent ultrasonography of the wrists and electrophysiological testing. Data from the patient and the control groups was compared for both the investigations to determine the CTS and the grade of severity.
Results:
There was a high degree of correlation between the conduction abnormalities of the median nerve as detected by electrodiagnostic tests, historic and objective scale [Hi-Ob] and the measurement of the cross-sectional area of the nerve by US (
P
< 0.05). A cut-off point of 0.88 mm
2
for the mean cross-sectional area of the median nerve was found to be the upper limit for normal values. Compared to Ultrasonography which found one hand negative, six hands (10%) were negative on the electrophysiological tests. Using critical CSA value of 1.0 mm
2
in these CTS cases by US with sensitivity and specificity of 100% and 88%. Based on the results of this study, ultrasonography of wrist is another useful tool along with nerve conduction studies as per sensitivity and specificity patterns found in our study in diagnosis of carpal tunnel syndrome.
Conclusion:
High-frequency US examination of the median nerve and measurement of its cross-sectional area can be strongly considered as useful diagnostic diagnostic modality for the evaluation of CTS along with nerve conduction studies. In addition to its high diagnostic accuracy it is able to define the cause of nerve compression, aids treatment planning and provides a reliable method to follow response to therapy.
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Antiepileptic Drug Prices, Availability and Affordability in a Resource-Limited Setting
Karan Singh, Raj K Setia, Suman Sharma, Namita Bansal, Rajinder K Bansal, Anurag Chaudhary, Sarit Sharma, Jatinder Singh Goraya, Shivani Kalra, Gagandeep Singh
September-October 2020, 23(5):674-680
DOI
:10.4103/aian.AIAN_264_19
Background:
The availability and affordability of antiepileptic drugs (AEDs) are critical to the success of public health initiatives enabling care for people with epilepsy in the community.
Objective:
To pilot survey the availability and affordability of AEDs in the community.
Methods:
Field workers used standard WHO–Health Action International approaches and collected data on the availability of, and maximum retail prices of originator brands and least price generics of AEDs in 46 randomly selected public (
n
= 29), private (
n
= 8), and charitable (
n
= 9) pharmacy outlets. Median price ratios were computed apropos international reference prices of corresponding medications and affordability gauged with reference to daily wage of lowest paid worker.
Results:
Only 10 outlets (7 – private, 3 – public, and none – charitable) stocked at least one essential AED. Median price ratios varied between 1.1 and 1.5 essentially reflecting the difference between the least price generics and originator brands. Of note, carbamazepine-retard, 200 mg put up the slightest difference in prices of originator and least price generic brands and also was the most affordable AED.
Conclusions:
The availability and affordability of most AEDs were poor and hence, this needs to be studied on a wider scale and thereafter efforts to improve both the availability and affordability are desirable in order to address the huge treatment gap for epilepsy in India.
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CASE REPORTS
Different clinical manifestations of three prime repair exonuclease 1 mutation: A case series
Faruk Incecik, Sibel Balci, Rabia Miray Kisla Ekinci, Ozlem M Herguner, Atil Bisgin, Mustafa Yilmaz
September-October 2020, 23(5):699-703
DOI
:10.4103/aian.AIAN_469_18
Three prime repair exonuclease 1 (
TREX1
) degrades single- and double-stranded DNA with 3’-5’ exonuclease activity.
TREX1
mutations are related to type 1 interferon-mediated autoinflammation owing to accumulated intracellular nucleic acids. Several cases of systemic lupus erythematosus, Aicardi–Goutieres syndrome (AGS), familial chilblain lupus (FCL), and retinal vasculopathy-cerebral leukodystrophy caused by
TREX1
mutations have been reported, so far. In this report, we described five patients with
TREX1
mutations from three families with three different disorders, which include AGS, FCL, and FCL with central nervous system vasculitis.
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ORIGINAL ARTICLES
Optimizing Investigations for Evaluation of Enlargements of the Roots, Plexuses and Nerves: A Study of 133 Patients
Satish Khadilkar, Narayan Dilip Deshmukh, Neha H Shah, Sunila Jaggi, Khushnuma A Mansukhani, Bhagyadhan Patel, Sonali Shah, Sarika Patil, Vanaja Shetty
September-October 2020, 23(5):666-673
DOI
:10.4103/aian.AIAN_504_19
Background and Aims:
A wide variety of neurological diseases result in clinical and/or radiological enlargement of nerves, roots and plexuses. With the advancement in techniques and use of magnetic resonance neurography (MRN), aided by electrophysiology, proximal segments of the lower motor neuron (LMN) can be well studied. The relative merits of investigative modalities have not been well defined and comprehensive information on this subject is sparse.
Methods:
This retrospective study included data from January 2010 to June 2018. Patients having clinical and/or radiological enlargements of lower motor neuron were included. Clinical and laboratory work up, electrophysiology, MRN and biopsy studies were documented and analyzed.
Results:
133 patients fulfilled the inclusion criteria. The diagnostic categories were of leprosy (32%), immune neuropathies (27.8%), nerve infiltrations (8.2%), inherited neuropathies (9%), diabetic radiculopathies (9%) and others (12.7%). MRN was essential to diagnosis in 24.8% and supportive in 31.5% patients. Electrophysiology was essential in diagnosis in 70.6%, biopsy in 45.8% and genetic studies in 6.4% patients.
Conclusion:
The manuscript presents a large cohort of diseases causing enlargement of LMN with clinical and investigative aspects of 7 patients of the most unusual condition of chronic immune sensorimotor polyradiculopathy (CISMP) and details of 7 other patients with chronic mononeuropathies at non-entrapment sites. A table of comparative utility and an algorithm depicting the optimization of investigations has been presented.
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Economic Burden of Acute Stroke Care in Beneficiaries and Non-Beneficiaries under Social Security Schemes at Tertiary Care Hospitals of Western Rajasthan
Divya Goswami, Kuldeep Singh, Pankaj Bhardwaj, Samhita Panda, Akhil Goel, Nitin Joshi, Subhkaran Khichar, Inder Puri
September-October 2020, 23(5):661-665
DOI
:10.4103/aian.AIAN_393_19
Objective:
A cost of illness study was conducted with aims to asses various cost of acute stroke care and its determinants among beneficiary (patients enrolled in any social security scheme) and non beneficiary (patients not enrolled in any social security scheme) of various social security schemes.
Method:
A cross-sectional study was conducted at government hospitals in western Rajasthan from March to May 2019. All consecutive stroke patients were enrolled during study period. Data related to socio-demographic, disease-related and cost-related data was collected by direct patient and main caregiver’s interview. Primary study outcome was description of direct and indirect cost of acute stroke care among beneficiary and non beneficiary patients. Secondary outcome was description of determinants of cost or significant cost-driven variables.
Results:
Total of 126 stroke patients were enrolled in 3 months. Mean age was 57.67 ± 15.0 and male: female ratio was 82:44. Both beneficiary and non-beneficiary patients were similar in baseline characteristic except monthly income (
P
< 0.01) Mean hospital stay was 6.52 ± 2.23 Total out of pocket direct cost among beneficiary was INR 12727.21 [95% C.I. 8658.50, 16795.92] and among non beneficiary was INR 23649.68 [95%C.I. 18591.37, 28707.99]. There was significant difference indirect cost of beneficiary and non-beneficiary patients (
P
< 0.01). Mean Indirect cost (wages loss) among beneficiary was INR 12414.75 [95% C.I. 9691.13, 15138.37] and among non-beneficiary was INR 16460 [95% C.I. 13044.81, 19875.19]. There was no significant difference in Indirect cost of beneficiary and non-beneficiary patients (
P
= 0.06). Monthly income, stroke severity (modified Rankin score) and hospital stay were significant direct cost determinants.
Conclusion:
Public health insurance scheme reduces direct cost of acute stroke care significantly. Severity of stroke and prolonged hospital stay were main cost-driven variables.
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2,925
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Spectrum of Truncal Dystonia and Response to Treatment: A Retrospective Analysis
Sahil Mehta, Sucharita Ray, Kamalesh Chakravarty, Vivek Lal
September-October 2020, 23(5):644-648
DOI
:10.4103/aian.AIAN_542_20
Background:
Presence of truncal dystonia usually points to a secondary cause of dystonia like exposure to dopamine receptor blockers or neurodegenerative illness. Rarely, it can occur as an idiopathic focal or segmental dystonia.
Methods:
Retrospective review of medical records and videos of patients of truncal dystonia presenting in the Botulinum Toxin Clinic of Department of Neurology at Post Graduate Institute of Medical Education and Research, Chandigarh between May 2016 and February 2019.
Results:
A total of 16 patients with predominant truncal dystonia were recruited. There were ten males and six females with mean age of 49.1 ± 15.1 years (range 22–70). Extensor truncal dystonia was the most common (12/16) followed by camptocormia (4/16). Various etiologies included Idiopathic Parkinson’s disease (4/16), Tardive dystonia (5/16), Neurodegeneration with brain iron accumulation (genetically confirmed) (2/16) and idiopathic (5/16). All patients were refractory to a combination of oral medications tried over a period of 1.82 ± 1.93 years. All patients received electromyographic-guided botulinum toxin in paraspinals or rectus abdominis muscles depending upon the type of dystonia. The mean dose of abobotulinum toxin used was 286.7 ± 108.6 units (range 200–500 units) for paraspinals and 297.5 ± 68.5 (range 200–350) for rectus abdominis muscles per session. Average subjective response after botulinum toxin injection session was 31.2 ± 21.5% (range 0–70). No adverse effects were reported.
Conclusion:
Botulinum toxin is an acceptable alternative to patients presenting with medically refractory truncal dystonia and may offer modest benefit.
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3,003
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The Utility of Neuroimaging Parameters in Discriminating Patients of Normal-Pressure Hydrocephalus with Positive Cerebrospinal Fluid Tap Test Response from Healthy Controls
Halil Onder, Gurol Goksungur
September-October 2020, 23(5):625-631
DOI
:10.4103/aian.AIAN_583_19
Objective:
To investigate the frequency of previously defined neuroimaging signs of normal pressure hydrocephalus in our NPH patient group with positive cerebrospinal fluid (CSF) tap test response.
Methods:
Twenty-two patients with probable NPH and 33 healthy control individuals were enrolled in this study. Previously defined 9 parameters including Evan’s index, narrow high convexity sulci, dilation of the Sylvian fissures, focally enlarged sulci, enlargement of the temporal horns, callosal angle, periventricular hyperintensities, bulging of the lateral ventricular roof, and disproportionately enlarged subarachnoid space hydrocephalus were evaluated on conventional magnetic resonance imaging. A total radiological score was formed in both groups. The total radiological score, scores, and frequency of each radiological parameters were compared between patient and healthy control groups.
Results:
The mean age of the patient group was 67.31 ± 7.27 (F/M ratio was 7/15), whereas it was 69.09 ± 4.89 (F/M ratio was 11/22) in healthy control group. The result of these analyses revealed that scores of all the radiological parameters, except callosal angle score, were found to be higher in NPH patient group. The parameters with the highest positive predictive values were narrow high convexity sulci, narrowing of callosal angle, and DESH (100%, 100%, and 100%, respectively). On the other hand, enlargement of temporal horns had the highest negative predictive value among all parameters (96%).
Conclusion:
The results of our study support the use of neuroimaging parameters as an alternative method for CSF tap test. We suggest that in the presence of narrow high convexity sulci and/or narrowing of callosal angle, the decision of shunt surgery may be made in patients with suspicion of NPH, without performing CSF tap test. Confirmation of these results, in the future, large-scale studies may certainly provide critical perspectives to be used in the clinical practice.
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AIAN REVIEW
The Treatment of Vestibular Migraine: A Narrative Review
Youjin Shen, Xiaokun Qi, Tingyu Wan
September-October 2020, 23(5):602-607
DOI
:10.4103/aian.AIAN_591_19
Vestibular migraine (VM) is one of the most debilitating chronic diseases that is currently underdiagnosed and undertreated. The treatment of VM is a dynamic and rapidly advancing area of research. New developments in this field have the potential to improve the diagnosis and provide more individualized treatments for this condition. In this review, we discussed the progress of evidence-based treatment of VM, including pharmacotherapy and nonmedical methods. A search of the literature was conducted up to September 2019. In order to control or cure VM, patients should follow three steps. First, patients should comply with diet and behavioral medication; Second, during the attack of VM, patients should take medicine to control the symptoms. These acute attack treatment of VM consists of antiemetic medications (e.g., dimenhydrinate and benzodiazepines), anti-vertigo medicine, and analgesics (e.g. triptans). Third, prophylactic medicine (e.g., propranolol, topiramate, valproic aid, lamotrigine, and flunarizine) can be used to reduce the frequency and severity of VM attack. Also, vestibular rehabilitation (VR) treatment should be considered for all VM. Meanwhile, we also propose to establish a culture of prevention which is essential for reducing the personal, social and economic burden of VM.
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2,877
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5
CASE REPORTS
A case of monocytic pleocytosis in west nile virus encephalitis and review of the literature
Brian J Villafuerte Trisolini, Mohamed Taha, Maryam Samir Yousif Matloub, T Scott Diesing
September-October 2020, 23(5):687-688
DOI
:10.4103/aian.AIAN_103_19
West Nile Virus (WNV) encephalitis CSF findings are usually described as polymorphonuclear pleocytosis initially followed by lymphocytic pleocytosis. We report a 68-year-old female with WNV encephalitis monocytic pleocytosis and flaccid quadriparesis with ventral roots enhancement. We suggest the inclusion of neuroinvasive WNV in the differential of encephalopathy with flaccid paralysis despite a monocytic pleocytosis. We also suggest the consideration of neuroinvasive in acute polyneuropathies unresponsive to immunotherapies.
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2,525
349
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LETTERS TO THE EDITOR
Acetazolamide-Induced agranulocytosis in a patient with pseudotumor cerebri
Faruk Incecik, Neslihan Ozcan, Duygu G Ozcanyuz, Gulen G Mert
September-October 2020, 23(5):732-733
DOI
:10.4103/aian.AIAN_58_19
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2,395
384
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Pyridoxine trial in early infantile epileptic encephalopathy: Never forget!
Indar Kumar Sharawat, Renu Suthar, Arushi Gahlot Saini, Naveen Sankhyan
September-October 2020, 23(5):727-729
DOI
:10.4103/aian.AIAN_204_19
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2,380
389
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Acute intermittent porphyria and posterior reversible encephalopathy syndrome
Mansoor C Abdulla
September-October 2020, 23(5):711-712
DOI
:10.4103/aian.AIAN_233_19
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2,292
398
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Anti-GQ1b IgG and anti GD1b IgG positive recurrent miller fisher syndrome
Naseem Palakkuzhiyil, Alai Taggu, Sharmina Saleem, NA Uvais
September-October 2020, 23(5):729-730
DOI
:10.4103/aian.AIAN_253_19
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[CITATIONS]
2,266
362
1
Celiac disease in a boy with duchenne muscular dystrophy: A double jeopardy!
Indar K Sharawat, Shruti Sharma, Renu Suthar, Babu R Thapa
September-October 2020, 23(5):731-732
DOI
:10.4103/aian.AIAN_40_19
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2,254
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A low-excretor biochemical phenotype of glutaric aciduria type I: Identification of novel mutations in the glutaryl coa dehydrogenase gene and review of literature from India
Muntaj Shaik, Mahesh Kamate, TP Kruthika-Vinod, Anakala Basappa Vedamurthy
September-October 2020, 23(5):724-726
DOI
:10.4103/aian.AIAN_188_19
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2,227
368
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Steroid responsive acute isolated ophthalmoplegia: A rare presentation of anti-GQ1b antibodies syndrome
Divyani Garg, VY Vishnu, MB Singh, Vinay Goyal, MV Padma Srivastava
September-October 2020, 23(5):739-740
DOI
:10.4103/aian.AIAN_287_19
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2,148
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EDITORIAL COMMENTARY
Caregiver Burnout in Parkinson's: Time to Address
Sujith Ovallath
September-October 2020, 23(5):586-586
DOI
:10.4103/aian.AIAN_283_20
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ORIGINAL ARTICLES
MRI Spectrum of
Haemophilus influenzae
Meningoencephalitis in Children
Sameer Vyas, Renu Suthar, Vivek Agarwal, Nidhi Bhardwaj, Manila Salaria, Ritu Aggarwal, Paramjeet Singh, Ronny Wickström, Pratibha Singhi, Sunit Singhi
September-October 2020, 23(5):616-620
DOI
:10.4103/aian.AIAN_500_19
Background and Purpose:
Haemophilus influenzae
type b (Hib) infection occurs mostly in children and is transmitted from person to person through the respiratory pathway. Hib strain is associated with meningitis or encephalitis. It is not an uncommon infection, particularly, in the developing world. This prospective cohort study was done with the aim of describing imaging findings in patients with Hib meningoencephalitis.
Materials and Methods:
In a prospective cohort study, consecutive children admitted in the pediatric emergency unit with acute febrile encephalopathy were enrolled. The clinical details, CSF analysis, and microbiological and serological investigations were recorded on a case record proforma. Children with confirmed Hib meningoencephalitis were included in this study. Clinicoradiological features were assessed.
Results:
A total of 16 patients with acute febrile encephalopathy, in whom CSF latex agglutination, CSF culture, or CSF multiplex PCR were positive for
H. influenzae
were included in this study. All these children were investigated with magnetic resonance imaging (MRI) brain. Important imaging findings were meningitis, predominantly around frontoparietal lobes (43%), cerebritis (28%), ventriculitis (14%), and subdural collections (21.5%). One patient had features consistent with acute disseminated encephalomyelitis (ADEM) while four patients had normal MRI scan.
Conclusions:
H. influenzae
is still a common cause of meningitis in infants and children in the developing world. We have tried to study the most common MRI features associated with Hib infection to help radiologists alert the treating clinicians to further investigate these patients for appropriate prognostication.
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2,305
59
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LETTERS TO THE EDITOR
Vivid visual hallucinations in visually impaired: Charles bonnet syndrome – An analog to “phantom-limb phenomenon”
Ananya Das, Gutti Nagendra Babu, Ankit Gupta, Vikas Kanaujia, Vimal Kumar Paliwal
September-October 2020, 23(5):734-735
DOI
:10.4103/aian.AIAN_40_20
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2,162
133
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Golfer's myelopathy: Is it like surfer's myelopathy?
Seok-Yeol Yang, Jong-Mok Lee
September-October 2020, 23(5):714-715
DOI
:10.4103/aian.AIAN_266_19
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ORIGINAL ARTICLES
Brain MRI in Epstein–Barr Virus Meningoencephalitis in Children
Sameer Vyas, Renu Suthar, Vikas Bhatia, Nidhi Bhardwaj, Ritu Aggarwal, Pratibha Singhi, Sunit Singhi
September-October 2020, 23(5):621-624
DOI
:10.4103/aian.AIAN_537_19
Background and Purpose:
Epstein–Barr virus (EBV) meningoencephalitis can have variable and nonspecific brain magnetic resonance imaging (MRI) findings in children. This study was done with the purpose of describing brain MRI findings in children with EBV meningoencephalitis.
Materials and Methods:
The study included 45 pediatric patients that presented with variable neurological symptoms and were found to have EBV meningoencephalitis based on positive EBV deoxyribonucleic acid (DNA) in the cerebrospinal fluid. All these patients had undergone brain MRI. Clinical and radiological features were evaluated.
Results:
Fever was a presenting feature in all cases. Signs of meningitis and raised intracranial pressure (ICP) were seen in 24 (53.3%) cases, encephalopathy in 15 (33.3%), and seizures were present in 33 (73.3%). MRI was abnormal in 29 (64.4%) patients. The cortical/subcortical pattern was diagnosed in 9 (20%) cases, white matter involvement in 7 (15.5%), basal ganglia in 5 (11.1%), thalamic involvement in 4 (8.8%), brain stem involvement in 2 (6.2%), substantia nigra involvement in 2 (4.4%), and cerebellar involvement in 2 (4.4%). Diffusion restriction was present in 11 (24.4%) cases and susceptibility changes in 7 (15.5%). Meningeal enhancement was present in 10 (22.2%) cases. In addition, brain abscess and subdural effusion/empyema were present in 1 (2.2%) case each.
Conclusion:
Pediatric EBV meningoencephalitis has varied clinicoradiological spectrum and there is no specific MRI pattern to characterize the meningoencephalitis on imaging. Common MRI findings include cortical-subcortical involvement, white matter changes, basal ganglia, and thalamic involvement.
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LETTERS TO THE EDITOR
Epilepsy in ring chromosome 20 syndrome might have variable clinical features
Abhijit Anil Patil, KP Vinayan, Arun Grace Roy
September-October 2020, 23(5):718-722
DOI
:10.4103/aian.AIAN_32_20
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2,042
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EDITORIAL COMMENTARY
Neurology and COVID-19: Time to burn the candle at both ends
Achal K Srivastava, Divyani Garg
September-October 2020, 23(5):584-585
DOI
:10.4103/aian.AIAN_652_20
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LETTERS TO THE EDITOR
Nummular headache responding to oxcarbazepine: A rare case
Jalpan Patel, Devangi Desai, Soaham Desai
September-October 2020, 23(5):722-724
DOI
:10.4103/aian.AIAN_7_20
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ORIGINAL ARTICLES
Assessing autonomic nervous function by heart rate variability and heart rate turbulence in patients with acute ischemic stroke
Mustafa Candemir, Halil Onder
September-October 2020, 23(5):608-615
DOI
:10.4103/aian.AIAN_647_19
Background:
Acute ischemic stroke (AIS) induces adverse effects on the cardiovascular system by affecting the autonomic nervous system (ANS).
Objectives:
This study aimed to determine whether the parameters of heart rate variability (HRV) and heart rate turbulence (HRT) differed in patients with AIS as compared to that in the control group. Furthermore, we aimed to determine the differences in the involvement of the ANS between right and left hemisphere (LH) strokes.
Methods:
A
total of 148 [74 right hemispheres (RH) and 74 left hemispheres] patients with AIS and 80 control subjects were included in the study. The Holter device was used to obtain elcctrocardiogram readings for over 20 h from all patients. Results of HRV and HRT parameters [Tonset (TO) and Tslope (TS)] were acquired through an automatic analysis of the program.
Results:
All HRV parameters were found to be low in patients with AIS (
P
< 0.05, for all parameters). TO and TS were disrupted in 99 patients with AIS (66.8%) and in 15 control subjects (18.7%) (HRT–1 and HRT–2 groups,
P
= <0.001). HRV parameters were detected to be similar in patients, irrespective of the left or right infarct. TO and TS were normal in 31 patients (41.9%) with left hemisphere localization and in only 18 patients (24.3%) with right hemisphere localization.
Conclusions:
Combined evaluation of HRV and HRT parameters may provide important information regarding the alterations in the ANS in patients with AIS. The utility of HRT in the determination of ANS alterations in patients with AIS should be investigated in larger future prospective studies.
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Knowledge, attitude, and practice (KAP) Study on Serotonin Syndrome Among Neuro Physicians
Sanjay Prakash, Chaturbhuj Rathore, Kaushik Rana
September-October 2020, 23(5):638-643
DOI
:10.4103/aian.AIAN_603_19
Background and Aims:
Serotonin syndrome (SS) is a highly underdiagnosed drug-induced clinical syndrome. Under diagnosis is partly due to the unawareness of this syndrome by physicians. The aim of this study is to assess the knowledge, attitude and practice of SS among neuro physicians in India.
Methods:
A
cross-sectional survey using a self-administered questionnaire was carried out among neuro physicians in India. Neuro physicians attending the various neurological conferences and meetings were approached to participate in the study.
Result:
A
total of 150 neuro physicians responded to the survey. About 31% of participants correctly recognized the criteria for SS. Only 17% of the neuro physicians considered clonus as the most important feature in SS. Very few physicians correctly identified serotonergic agents causing serotonin syndrome. Similarly, a very low percentage of neuro physicians correctly identified the drugs used in the management of SS. Drugs used for the treatment of SS were incorrectly recognized as drugs causing SS. Clonus is the most specific feature for SS. However, examination for clonus is not a routine phenomenon in clinical practice among neuro physicians.
Conclusion:
This study shows great deficiencies in all domains of SS among neuro physicians. There is a need to make every doctor aware of SS by educational programs.
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Neuropsychiatric Symptoms and Caregiver Burden in Parkinson's Disease
Abhishek Juneja, Kuljeet Anand, Mina Chandra, Smita Deshpande, Rajinder Dhamija, Parul Kathuria, Rahul Mahajan
September-October 2020, 23(5):656-660
DOI
:10.4103/aian.AIAN_91_20
Objective:
Parkinson’s disease (PD) is a neurodegenerative disorder. It has a significant impact on the quality of life of patients and their caregivers. The present study aims to study the phenomena of neuropsychiatric symptoms and their association with caregiver burden in PD.
Methods:
The study was conducted in 100 patients of Parkinson’s disease and their primary caregivers. The patients of PD were diagnosed on the basis of UK Brain Bank criteria; severity/staging of Parkinson’s disease was done by Movement Disorder Society - Unified Parkinson’s disease rating scale (MDS-UPDRS-III). Patients who fulfilled inclusion and exclusion criteria were recruited for the study. The neuropsychiatric evaluation was based on Neuropsychiatric Inventory-Questionnaire (NPI-Q). Caregiver burden was assessed with the Zarit Caregiver Burden Inventory (ZCBI).
Results:
Mean age of PD patients was 61.48 ± 6.71 years, majority of them were males (68%). Mean total NPI score of patients was 44.46 ± 5.38. Mean age of caregivers was 52.26 ± 6.80 years, majority of them were females (72%) and spouse (76%) in relation to the patient. Caregiver burden was significantly related to age of the patient, duration of illness, severity of illness, and total NPI score.
Conclusion:
Neuropsychiatric symptoms significantly contribute to the caregiver burden in Parkinson’s disease.
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LETTERS TO THE EDITOR
Red ear syndrome: Case series and review of a less recognized headache disorder
Ishani Patel, Devangi Desai, Soaham Desai
September-October 2020, 23(5):715-718
DOI
:10.4103/aian.AIAN_1_20
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Hybrid carotid revascularization with transient flow reversal
Boby Varkey Maramattom, Reji Paul, E Nidhin, T Jithendra, George Varghese Kurien
September-October 2020, 23(5):736-737
DOI
:10.4103/aian.AIAN_99_20
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ORIGINAL ARTICLES
Gender Differences in Impulse Control Disorders and Related Behaviors in Patients with Parkinson's Disease and its Impact on Quality of Life
Birinder S Paul, Gurjot Singh, Nahush Bansal, Gaganeep Singh, Gunchan Paul
September-October 2020, 23(5):632-637
Background:
Dopaminergic medications administered to remedy motor symptoms in Parkinson’s disease are associated with an enhanced risk for impulse control disorders (ICD) and related compulsive behaviors (ICD-RB). Thus, the present study focuses on investigating the gender difference in the prevalence of ICD-RBs in Indian PD patients on dopamine replacement therapy (DRT), its impact on quality of life and to identify ICDs relevant in Indian scenario apart from the criteria set in QUIP-RS.
Method:
This was a hospital-based observational cross-sectional study in which Parkinson’s disease patients attending neurology clinic were included. Complete details of anti-parkinsonian therapy along with demographic and clinical variables were recorded on a predesigned Performa. Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s disease (QUIP), which is a validated quick screening tool, was used to detect ICD-RBs. The relative frequency and comparative impact of ICD on health-related quality of life (QOL) was studied using validated PDQ-39 Questionnaire.
Results:
Out of 102 patients, at least one ICD or ICD-RB was present in 41.19% and ≥2 ICD-RBs were present in 15.59%. At least one ICD was present in 16.67%, any ICD-related compulsive behaviors was present in 34.31% patients. The most common was punding and compulsive medication use (12.75% each), followed by hobbyism (7.84%), compulsive eating (6.86%), pathological gambling (3.92%), and hypersexuality, walkabout, and compulsive shopping (2.94% each). ICDs not classified elsewhere such as trichotillomania were found 3 patients (2.94%). ICD-RBs showed a trend to be more frequent in women (44.82% women vs. 39.39% men). As compared with patients without ICD-RBs, those with ICD-RBs were found to have higher dose of LD and DA and higher Hoehn and Yahr stage. ICD-RBs have a negative impact on the quality of life of Parkinson’s disease patients.
Conclusion:
ICDs and ICD-RBs have been included in the behavioral spectrum of nonmotor symptoms in PD. PD patients are at increased risk of developing ICD-RBs which interfere with important activities and have obligation in ordinary life, leading to legal and psychological consequences with a great impact on QOL.
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EDITORIAL COMMENTARY
Epilepsy treatment gap in India: Is it too high a peak to scale?
Chaturbhuj Rathore, Kurupath Radhakrishnan
September-October 2020, 23(5):580-580
DOI
:10.4103/aian.AIAN_919_20
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LETTERS TO THE EDITOR
Clinodactyly – A clinical clue to diagnose a hereditary periodic paralysis
Jasmine Parihar, Venugopalan Y Vishnu, Mamta B Singh, Vinay Goyal, MV Padma Srivastava
September-October 2020, 23(5):738-739
DOI
:10.4103/aian.AIAN_400_20
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IMAGES IN NEUROLOGY
Pseudo-subarachnoid Hemorrhage in a Patient with Acute on Chronic Respiratory Failure
Sarbesh Tiwari, Pawan Kumar Garg, Preetham Patavardhan, Nishant Kumar Chauhan, Suryanarayanan Bhaskar, Pushpinder Singh Khera
September-October 2020, 23(5):706-708
DOI
:10.4103/aian.AIAN_257_20
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LIGHTER MOMENTS (ARTWORK OR PHOTOGRAPHY)
‘Z Plus Corden’ during Covid Times
Ajith Cherian
September-October 2020, 23(5):710-710
DOI
:10.4103/aian.AIAN_397_20
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Quadriparesis: An Ode to Defiance
Divyani Garg
September-October 2020, 23(5):709-709
DOI
:10.4103/aian.AIAN_418_20
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EDITORIAL COMMENTARY
Botulinum Toxin Injection in Truncal Dystonia: Time to Take Note
Supriyo Choudhury, Hrishikesh Kumar
September-October 2020, 23(5):579-579
DOI
:10.4103/aian.AIAN_822_20
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AIAN REVIEW
Insight into Neurodegenerative Disorder Using Melanocytes as a Model System
Shalini Yadav
September-October 2020, 23(5):598-601
DOI
:10.4103/aian.AIAN_466_19
Background:
Neural crest cells (NCCs) by responding to several signals and paracrine factors get differentiated into different lineages like peripheral nervous system (PNS), chondrocytes, myofibroblast, endocrine, melanocytes, etc., Melanocytes are pigment-producing cells that share a common origin, paracrine factors (Wnt, FGF, and BMP), and transcription factors (TFs) with the neurons of the nervous system.
Objective:
Neuronal model for neurodegenerative disorders are limited because of their nonhuman origin and transformation. In this review we propose the use melanocyte as a model system to study neurodegenerative studies.
Method:
Systematic Literature Review.
Results:
The similarity between neural crest-derived melanocytes and neurons, makes melanocyte an important model to study several neurodegenerative disorders like Alzheimer’s disease and Parkinson’s disorder.
Conclusion:
Melanocytes and neurons share common origin i.e. both arise from NCC and share identical signalling molecules and pathways. Neural crest-derived melanocytes can thus serve as a promising model system to study normal and pathological behaviour of less accessible neurons.
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VIEW POINT
Virtual Care for Neurological Practice
Ramana Appireddy, Nathaniel Bendahan, JS K Chaitanya, Garima Shukla
September-October 2020, 23(5):587-591
DOI
:10.4103/aian.AIAN_415_20
The COVID-19 crisis has worsened the pre-existing barriers to accessing neurological specialist care in Low and middle income countries. Telemedicine has been available for well over 2 decades but has not been widely adopted in LMIC’s due to issues around cost, feasibility, infrastructure and regulation. Virtual care is an offshoot of traditional telemedicine leveraging the widely available internet enabled devices to connect patients with their healthcare providers. In this manuscript, we provide an overview of the virtual care, relevance to neurology and some guidance on implementing virtual care in an Indian context.
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LETTERS TO THE EDITOR
Uncommon neurological complications of levamisole
Prasanna V Eswaradass, Balamurugan Namasivayam
September-October 2020, 23(5):713-714
DOI
:10.4103/aian.AIAN_57_19
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EDITORIAL COMMENTARY
Impulse control disorders in Parkinson's disease
Shakya Bhattacharjee
September-October 2020, 23(5):581-581
DOI
:10.4103/aian.AIAN_440_20
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IMAGES IN NEUROLOGY
Corpus Callosal Hemorrhage: A Rare Presentation of Extensive Cerebral Venous Thrombosis
Patel Vishal Ganeshbai, Ashok V Reddy Taallapalli, P Praveen Sharma, K Karthik, Saraswati Nashi, Girish B Kulkarni, Suvarna Alladi
September-October 2020, 23(5):704-705
DOI
:10.4103/aian.AIAN_25_20
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EDITORIAL COMMENTARY
Cerebral Venous Thrombosis: A Critical Appraisal
Amos Lal, Andrew C F. Hui
September-October 2020, 23(5):582-583
DOI
:10.4103/aian.AIAN_814_20
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© 2006 - Annals of Indian Academy of Neurology | Published by Wolters Kluwer -
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Online since 1
st
March, 2006