Annals of Indian Academy of Neurology
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Role of occupational therapy after stroke
Tennille J Rowland, Deirdre M Cooke, Louise A Gustafsson
January 2008, 11(5):99-107
Internationally recognized best practice care in the early management and rehabilitation of individuals following stroke includes multidisciplinary assessment and treatment by a coordinated team of health care professionals that includes occupational therapists. Occupational therapists assess the impact of changes in motor function, sensation, coordination, visual perception, and cognition on a person's capacity to manage daily life tasks. Intervention improves participation in meaningful roles, tasks, and activities; remediates deficits; minimizes secondary complications; and provides education and support to the patient and caregivers. Occupational therapists' focus on independence and function, individual goal-setting, and their specialist skills in task adaptation and environmental modification underpin the profession's contribution to the multidisciplinary stroke rehabilitation team. The aim of this paper is to provide an overview of occupational therapy practice in stroke patients.
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Terminal latency index, residual latency, and median-ulnar F-wave latency difference in carpal tunnel syndrome
Aslihan Uzunkulaoglu, Sevgi Ikbali Afsar, Betul Tepeli
April-June 2019, 22(2):175-179
DOI:10.4103/aian.AIAN_276_18  PMID:31007429
Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, but no electrodiagnostic test alone shows sufficient sensitivity for CTS. We aimed to investigate the value of median motor terminal latency index (mTLI), median motor residual latency (mRL), and median-ulnar F-wave latency difference (FdifMU) as additional tests to nerve conduction studies which are performed traditionally in electromyography laboratories. Methods: This is a retrospective study. The results of electrodiagnostic studies performed on patients with CTS were examined. We divided the enrolled hands of the patients diagnosed with CTS into two groups: affected hands with abnormal electroneuromyographic parameters indicating CTS diagnosis (CTS group) and hands with normal electroneuromyographic parameters (control group). Then, we analyzed the results of these completed electrodiagnostic studies. Results: A total of 320 hands of 160 patients were studied. FdifMU and mRL were found to be significantly higher in CTS group compared with the control group (P < 0.001). mTLIs were found to be significantly higher in control group compared with the CTS group (P < 0.001). Given that, the area under the curve is more than 70% for mTLI and mRL, but not for FdifMU. Conclusion: When combined with mMDL, both mTLI and mRL have excellent specificity for the diagnosis of mild and moderate CTS. However, the sensitivities for both parameters were lower. In suspected patients, FdifMU can be an additional tool for the diagnosis of CTS also, but alone it is not valuable.
  106,725 48 -
The diagnosis and management of pseudoseizures or psychogenic non-epileptic events
Aline J.C Russell
April-June 2006, 9(2):60-71
Pseudoseizures or psychogenic non-epileptic seizures (PNES) are often misdiagnosed as epilepsy. This review discusses what is known about PNES, the importance of differentiating PNES from epileptic seizures (ES), avoiding iatrogenic harm and of identifying and managing the underling psychological stressors to optimise outcome. Clinical suspicion and careful history taking with witness accounts is mandatory. Supportive investigations including video-EEG (VEEG) and the utility of VEEG and provocation are discussed. Resources to diagnose and manage PNES are an issue for most countries and clinical expertise may also be lacking. VEEG is an expensive diagnostic tool and there is variable collaboration between neurology and psychiatry which will influence how patients are managed. Confounding this, is the lack of evidence for best practice in managing PNES. The prognosis for the majority of patients with PNES appears to be poor, despite a wider recognition of the problem. Well conducted studies are needed to test the different treatment options.
  105,506 1,181 3
Cardioembolic stroke: An update on etiology, diagnosis and management
Megan C Leary, Louis R Caplan
January 2008, 11(5):52-63
Stroke and ischemic heart diseases are among the most common causes of death and disability throughout the world. Even more worrisome is the suggestion that stroke rates may further increase in certain developing nations. The purpose of this article is to review the particular subtype of stroke known as cardioembolic stroke. A cardioembolic stroke occurs when the heart pumps unwanted materials into the brain circulation, resulting in the occlusion of a brain blood vessel and damage to the brain tissue. The etiology, clinical manifestations, diagnosis and management of cardioembolic stroke are reviewed.
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Asymmetric crying facies in a neonate with congenital hypoplasia of depressor anguli oris muscle (CHDAOM)
Sujit A Jagtap, Kaustubh S Chaudhari
January-March 2016, 19(1):123-124
DOI:10.4103/0972-2327.168638  PMID:27011644
  80,855 93 -
The origin of HIV and AIDS: An enigma of evolution
Sarosh M Katrak
January-March 2006, 9(1):5-10
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The effect of curcumin (turmeric) on Alzheimer's disease: An overview
Shrikant Mishra, Kalpana Palanivelu
January-March 2008, 11(1):13-19
DOI:10.4103/0972-2327.40220  PMID:19966973
This paper discusses the effects of curcumin on patients with Alzheimer's disease (AD). Curcumin (Turmeric), an ancient Indian herb used in curry powder, has been extensively studied in modern medicine and Indian systems of medicine for the treatment of various medical conditions, including cystic fibrosis, haemorrhoids, gastric ulcer, colon cancer, breast cancer, atherosclerosis, liver diseases and arthritis. It has been used in various types of treatments for dementia and traumatic brain injury. Curcumin also has a potential role in the prevention and treatment of AD. Curcumin as an antioxidant, anti-inflammatory and lipophilic action improves the cognitive functions in patients with AD. A growing body of evidence indicates that oxidative stress, free radicals, beta amyloid, cerebral deregulation caused by bio-metal toxicity and abnormal inflammatory reactions contribute to the key event in Alzheimer's disease pathology. Due to various effects of curcumin, such as decreased Beta-amyloid plaques, delayed degradation of neurons, metal-chelation, anti-inflammatory, antioxidant and decreased microglia formation, the overall memory in patients with AD has improved. This paper reviews the various mechanisms of actions of curcumin in AD and pathology.
  69,419 1,786 66
Akinetic rigid syndrome: An overview
Praveen Gupta, Madhuri Behari
January-March 2007, 10(1):21-30
Akinetic-rigid syndromes can be caused by diverse etiologies. It is vital to separate idiopathic Parkinson's disease from other neurodegenerative diseases and causes of secondary parkinsonism as it has significant therapeutic implications. However even specialists may misdiagnose nonidiopathic parkinsonism as Parkinson's disease in a quarter of cases. Often the history may be nonspecific and all investigations may be normal. The diagnosis may thus rest entirely on clinical features. The etiological diagnosis of Akinetic rigid syndrome has critical therapeutic and prognostic implications. Therefore we will review the various etiologies of akinetic rigid syndrome and highlight critical clinical features to aid in differential diagnosis.
  58,862 1,369 -
Clinical mimickers of amyotrophic lateral sclerosis-conditions we cannot afford to miss
Nishita Singh, Sucharita Ray, Achal Srivastava
July-September 2018, 21(3):173-178
DOI:10.4103/aian.AIAN_491_17  PMID:30258257
Giving a diagnosis of amyotrophic lateral sclerosis to a patient is akin to handing out a death certificate. However, not all patients presenting with the classical dysphagia, wasting, and weakness may have motor neuron diseases. In these cases, it is extremely important not to miss little cues which can suggest an alternative diagnosis and in many cases a lease of life in terms of a treatment option. In this review, we consider some clinical scenarios that can present with the same symptom complex as diseases involving motor neurons but have a different anatomical or etiopathological basis and in many cases even a therapeutic option.
  57,676 366 -
Study of wrist ratio and wrist-to-palm index radio in individuals suffering from carpal tunnel syndrome
Suchitra Sachin Palve, Sachin Bhaskar Palve
April-June 2019, 22(2):159-163
DOI:10.4103/aian.AIAN_343_18  PMID:31007426
Background: Carpal tunnel syndrome (CTS) is the commonest median nerve entrapment neuropathy, with preponderance in females. Aims and Objective: The aim of the present study was to find out wrist ratio (WR) and wrist/palm ratio (WPR) in clinically diagnosed patients of CTS. Methodology: One hundred individuals (fifty patients of CTS and fifty as control group) aged between 30 and 50 years were recruited for the study. Early confirmation of clinically suspected patients of CTS was done by performing electrodiagnostic tests of median and ulnar nerves. Motor and sensory conduction velocities, distal motor and sensory latencies, and F-wave latencies were performed in the recruited volunteers. Results: The values for mean wrist ratio in control groups were 0.694, 0.703 respectively, and in patients with carpal tunnel syndrome, it was 0.704 and 0.719 respectively in moderate and severe type. The mean wrist to palm ratio (WPR) in control group was 0.371, while in patients with CTS, it was 0.374, 0.382, 0.387, and 0.401 based on progression of severity. Both were statistically significant for the last two groups (wrist to index finger [WIF] >4.4 m/s, moderate, and WIF nonrecordable, severe). Statistically significant (P < 0.001) decrease of motor conduction velocities for median nerve was seen in the CTS group as compared to control group. Statistically significant (P < 0.001) increase in distal motor and sensory latencies was observed for both median and ulnar nerves in CTS group with more increase in distal motor latency than sensory latency. Increase in F-wave latencies of both nerves was seen in CTS group. Conclusion: The study results confirm selective slowing of sensory and motor conduction within wrist-to-palm segment in patients of CTS. Both WR and WPR have a progressive correlation with the severity of CTS, but statistically significant changes were seen in the groups with moderate and severe CTS. Thus, WR/WPR can act as one of the essential parameters in the diagnosis of CTS with moderate-to-severe CTS.
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Psychiatric symptoms in neurological practice
M Madhusudanan
April-June 2006, 9(2):72-89
Most of the primary psychiatric symptoms like delusions, hallucinations, illusions, depression, mania, obsessive compulsive symptoms, aggression etc can occur in organic neurological illnesses. Neurologist should have a clear understanding as to the differentiating clinical features from organic neurological and medical causes. The present review focuses on the clinical differentiating points which can help the neurologist to exclude organic aetiology.
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Neurological complications of chickenpox
AS Girija, M Rafeeque, KP Abdurehman
October-December 2007, 10(4):240-246
Aim: To assess the neurological complications of chickenpox with prognosis. Background: The neurological complications occur in 0.03% of persons who get chickenpox. There is no universal vaccination against chicken pox in India. Most patients prefer alternate modalities of treatment. Hence these complications of chickenpox are likely to continue to occur. Study Design: A prospective study was conducted for 2 years (from March 2002) on the admitted cases with neurological complications after chickenpox (with rash or scar). Patients were investigated with CT/MRI, CSF study, EEG and nerve conduction studies and hematological workup. They were followed-up for 1 year and outcome assessed using modified Rankin scale. Results: The latency for the neurological complications was 4-32 days (mean: 16.32 days). There were 18 cases: 10 adults (64%) and 8 children (36%). Cerebellar ataxia (normal CT/MRI) was observed in 7 cases (32%) (mean age: 6.85 years). One patient (6 years) had acute right hemiparesis in the fifth week due to left capsular infarct. All these cases spontaneously recovered by 4 weeks. The age range of the adult patients was 13-47 years (mean: 27 years). The manifestations included cerebellar and pyramidal signs (n-4) with features of demyelination in MRI who recovered spontaneously or with methylprednisolone by 8 weeks. Patient with encephalitis recovered in 2 weeks with acyclovir. Guillain Barre syndrome of the demyelinating type (n-2) was treated with Intravenous immunoglobulin (IVIG) and they had a slow recovery by a modified Rankin scale (mRs) score of 3 and 2 at 6 months and 1 year, respectively. One case died after hemorrhage into the occipital infarct. There were two cases of asymmetrical neuropathy, one each of the seventh cranial and brachial neuritis. Conclusion: Spontaneous recovery occurs in post-chickenpox cerebellar ataxia. Rarely, serious complications can occur in adults. The demyelinating disorders, either of the central or peripheral nervous system, can be effectively managed using methylprednisolone or I/V IG.
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Treatment guidelines for Guillain-Barré Syndrome
AK Meena, SV Khadilkar, J. M. K. Murthy
July 2011, 14(5):73-81
DOI:10.4103/0972-2327.83087  PMID:21847334
  27,323 944 6
The role of the speech language pathologist in acute stroke
Cindy Dilworth
January 2008, 11(5):108-118
Dysphagia and communication impairment are common consequences of stroke. Stroke survivors with either or both of these impairments are likely to have poorer long-term outcomes than those who do not have them. Speech-language pathologists (SLP) play a significant role in the screening, formal assessment, management, and rehabilitation of stroke survivors who present with dysphagia and/or communication impairment. Early diagnosis and referral is critical, as is intensive intervention as soon as the patient is able to participate. The SLP is also responsible for educating carers and staff in strategies that can support the patient and for making appropriate environmental modifications (e.g. altering diet consistencies or providing information in an aphasia-friendly format) to optimize the stroke survivor's participation, initially, in the rehabilitation program and, subsequently, within the community.
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Management of treatment-resistant obsessive-compulsive disorder: An update on therapeutic strategies
Biswaranjan Mishra, Saddichha Sahoo, Baikunthanath Mishra
July-September 2007, 10(3):145-153
Background: Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder characterized by recurrent, persistent thoughts and/or repetitive compulsive behaviors that cause anxiety or distress, are time-consuming, and cause significant socio-occupational dysfunction. Although OCD can be alleviated with pharmacological and behavioral treatments, up to 40-60% of patients do not have a satisfactory outcome. This paper aims to review the operational definitions and management of treatment-resistant OCD. Materials and Methods: A computerized search on Pubmed carried from 1980 to April 2006 led to the summarization of the results. Results: There are several strategies to manage treatment-resistant OCD. To start with, it is necessary to define it and differentiate it from other comorbid psychiatric disorders. Adequate trials of selective serotonin reuptake inhibitors (SSRIs), including clomipramine, at the maximum recommended dosages for at least 12 weeks needs to be tried, along with cognitive behavioral therapy (CBT), before trying out other modalities of treatment, which include ECT, rTMS, and neurosurgery. Conclusion: OCD has various clinical and therapeutic implications as it has a chronic course. Unless diagnosed and treated in an effective manner, it carries the risk of becoming resistant to treatment. This paper attempts to present an algorithm of management that can be followed in treatment-resistant OCD. It also emphasizes the need to maximize the effect of each course of treatment before moving on to the next step of management.
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An uncommonly common: Glossopharyngeal neuralgia
PM Singh, Manpreet Kaur, Anjan Trikha
January-March 2013, 16(1):1-8
DOI:10.4103/0972-2327.107662  PMID:23661955
Glossopharyngeal neuralgia is a relatively rare condition characterized by severe, paroxysmal episodes of pain localized to the external ear canal, the base of the tongue, the tonsil or the area beneath the angle of the jaw. This pain is many a times confused with Trigeminal Neuralgia and mistreated. There are various diagnostic and management dilemmas which are herein addressed in this review.
  25,401 388 3
Electrodiagnostic approach to carpal tunnel syndrome
Ajith Cherian, Abraham Kuruvilla
July-September 2006, 9(3):177-182
An algorithm for an electrophysiological approach to carpal tunnel syndrome is proposed. This technical note takes into account the standard tests, comparison tests and needle electromyography. If the standard tests are negative, a comparison study can be done to identify cases of minimal or very mild carpal tunnel syndrome (CTS). If comparison studies are negative, CTS can be ruled out and a search for other causes have to be made. If the standard tests are positive, carpal tunnel syndrome can be divided into extreme, severe,moderate and mild cases. Motor comparison study is useful in extreme CTS cases. Needle electromyography is a must in all cases where the standard tests are positive. This streamlined approach allows accurate diagnosis with minimum essential tests.
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Controlled release formulations in neurology practice
JK Pandit, S Singh, MS Muthu
October-December 2006, 9(4):207-216
Recently, controlled release (CR) pharmaceutical products have become a very useful tool in medical practice, offering a wide range of actual and perceived advantages to the patient. A CR product requires numerous considerations, like drugs suitable for CR formulations, techniques of fabrication and evaluation, factors affecting bioavailability of the parent drug, before it can actually be claimed to provide the purported benefits. Such complex considerations fall under the domain of pharmaceutical experts and clinicians, naturally, are not sufficiently aware and updated about these products and their biological consequences. Various CR formulations used in neurological practice are discussed in the present review. The clinical studies of the conventional and CR dosage form of the drugs used in neurology practice reflect the advantages of prescribing CR formulations over the conventional dosage forms.
  23,491 2,015 7
What are relative risk, number needed to treat and odds ratio?
Kameshwar Prasad
October-December 2007, 10(4):225-230
The effects of an intervention is best measured in a randomized controlled trial (RCT) and can be expressed in various ways using the measures such as risk difference, number needed to treat (NNT), relative risk or odds ratio. Risk difference (RD) is the difference in risk of the outcome event between control and experimental group. Control group is not exposed to the intervention, whereas experimental group is the one that is exposed to intervention. The risk of outcome event in the control group is also called baseline risk. The NNT is the inverse of the risk difference and indicates the number of patients required to be treated to avoid one additional outcome event. Risk difference and NNT are absolute measures of effect. Relative risk (RR) is a relative measure and is the ratio of the risk in the exposed group to that in the unexposed group. Relative risk reduction (RRR) is one minus RR and indicates the fraction (or percent) of baseline risk that reduces with exposure to the intervention. Odds ratio (OR) is ratio of odds of having the event in the exposed group to that in the unexposed group. These measures are suitable for different purposes and appeal to different constituencies. Odds ratio is the only measure suitable for use in logistic regression and case control studies.
  24,366 703 2
Very early mobilization following acute stroke: Controversies, the unknowns, and a way forward
Julie Bernhardt
January 2008, 11(5):88-98
Evidence that organized stroke-unit care results in better outcome has led to positive changes in stroke service delivery around the world. It is well accepted that stroke rehabilitation should commence as early as possible for optimal recovery to be achieved. Exactly how early rehabilitation should start is controversial. Early mobilization (getting up out of bed within 24 h of stroke onset) is a well-established feature of acute stroke care in many Scandinavian hospitals. Elsewhere in the world, stroke protocols enforce bed rest for the first few days or foster long periods of bed rest after stroke. This paper aims to provide an overview of the topic of very early mobilization (VEM). It is divided into three sections: section 1 reviews the effects of bed rest and outlines arguments both for and against enforced bed rest after stroke; in section 2, VEM as a treatment for stroke and the limitations of existing literature in the field are described; and section 3 outlines the systematic approach that has been taken by our team of clinical researchers to the study the effect of VEM after stroke. Conclusion: VEM represents a simple, easy-to-deliver intervention, requiring little or no equipment. It is potentially deliverable to 85% of the acute stroke population and, if proven to be effective, may help reduce the significant personal and community burden of stroke. As current opinion about when mobilization should begin is divided, one way to move forward is through the conduct of a large high-quality clinical trial (such as A Very Early Rehabilitation Trial (AVERT)). Although some inroads have been made, further research in this field is clearly warranted
  24,371 652 2
Evolution of abnormal postures in Duchenne muscular dystrophy
Maria Kinali, Marion Main, Eugenio Mercuri, Francesco Muntoni
April-June 2007, 10(5):44-54
Spinal deformities are common abnormalities of posture observed in Duchenne Muscular Dystrophy (DMD). Spinal alignment is the result of the integrity of different variables, ranging from normal vertebral development to balance and symmetry of tone and strength, normal control by central pathways and integrity of the sensory feedback. Any disturbance altering one or more of these variables increases the risk for developing abnormal postures. Scoliosis is a frequent complication (68-90%) of DMD. Although the risk of developing scoliosis is higher in non-ambulant DMD patients, scoliosis and kyphosis can be found occasionally in ambulant patients. In DMD patients the onset and the evolution of the abnormal postures are related to the onset and the progression of weakness. This review discusses the factors affecting posture in DMD, especially in relation to scoliosis and gives an overview of general guidelines on the diagnostic approach and some management issues related to DMD.
  23,260 505 1
Practice trends in treating central nervous system tuberculosis and outcomes at a tertiary care hospital: A cohort study of 244 cases
Vinay Goyal, Arunmozhimaran Elavarasi, Abhishek , Garima Shukla, Madhuri Behari
January-March 2019, 22(1):37-46
DOI:10.4103/aian.AIAN_70_18  PMID:30692758
Introduction: Tubercular meningitis (TBM) is a common cause of chronic meningitis in India; however, there is a paucity of literature on optimum duration and choice of drug therapy. Materials and Methods: This was an ambispective cohort study. Results: Two hundred and forty-four patients of central nervous system tuberculosis (CNS TB) who were seronegative for HIV were studied of whom 198 had TBM and 46 patients had tuberculoma without meningitis. Before completion of treatment, 84% of TBM patients underwent imaging. There was no difference in disability or mortality in patients, who were treated with various drug regimens in terms of duration of therapy or number of drugs at initiation of treatment. However when patients developed new complications, adding more drugs improved survival. Prolonging corticosteroid administration in patients with nonsatisfactory improvement at 8 weeks was not associated with prevention of disability. Conclusions: CNS TB is treated by neurologists and physicians in India, as per their experience due to different recommendations in various guidelines. There is a tendency to decide when to stop treatment based on neuroimaging given the fear of poor outcomes associated with recurrence of the disease. The duration of treatment or choice of drugs at the start of treatment did not affect disability.
  21,747 355 -
All that ripples is not "Motor neuron disease"
Ashok Panagariya, Vinay Agarwal, Neeraj Agarwal
April-June 2007, 10(2):88-91
Until early 80's most patients presenting with lower motor neuron syndrome characterized by weakness, wasting, diminished reflexes, fasciculations, cramps and minimal sensory involvement would have been diagnosed as motor neuron disease- LMN variant. But similar clinical picture can be seen in various disorders right from degenerative illnesses like motor neuron disease to inflammatory ones like multifocal motor neuropathy (MMN). Some of them are potentially treatable conditions with immunomodulatory therapies and are associated with characteristic electrophysiological features and high serum antibody titers. Thus every patient presenting with pure motor LMN weakness and fasciculations should not be labeled as motor neuron disease and extensive electrophysiological search is warranted to diagnose these potentially treatable conditions, changing the grim prognosis to more favorable one.
  20,367 604 -
Antemortem diagnosis and prevention of human rabies
Shampur Narayana Madhusudana, Suja Mooriyath Sukumaran
January-March 2008, 11(1):3-12
DOI:10.4103/0972-2327.40219  PMID:19966972
Human rabies still continues to be a significant health problem in India and other developing countries where dogs are the major vectors of transmission. Rabies in humans can present in two clinical forms, i.e., furious and paralytic. While diagnosis of furious rabies can be made based on the typical symptoms and signs, paralytic rabies poses a diagnostic dilemma to the neurologists who may encounter these cases in their practice. Although there are certain clinical features that distinguish this disease from other forms of Guillain-Barre syndromes, confirmation of diagnosis may require laboratory assistance. Conventional techniques such as antigen detection, antibody assays and virus isolation have limited success. The recently introduced molecular techniques show more promise in confirming the cases of paralytic rabies. There has not been much success in the treatment of confirmed rabies cases and recovery from rabies is extremely rare. Therefore, preventive measures of this dreaded disease after an exposure become extremely important. The present article reviews the current status of human rabies with regard to antemortem diagnosis, disease management and post-exposure prophylaxis.
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Selected Abstracts of IANCON 2014

October 2014, 17(6):160-244
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