Browsing by Author "Cherian, A"

Now showing 1 - 11 of 11
  • Item
    Alpha coma evolving into spindle coma in a case of acute fulminant hepatic failure: What does it signify?
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2010) Das, A; Cherian, A; Dash, GK; Radhakrishnan, A
    A 44-year-old male developed acute fulminant hepatic failure of unknown etiology and expired within four days. His serial electroencephalograms (EEGs) showed diffuse background slowing on day one, which evolved into "alpha coma" and later into "spindle coma" over the ensuing two days. Such EEG transition is hitherto undescribed in patients with hepatic encephalopathy and gives fresh insight into the etiopathogenesis of specific EEG patterns in diffuse encephalopathy.
  • Item
    Central nervous system tuberculosis
    (AFRICAN HEALTH SCIENCES, 2011) Cherian, A; Thomas, SV
    Central nervous system (CNS) involvement, one of the most devastating clinical manifestations of tuberculosis (TB) is noted in 5 to 10% of extrapulmonary TB cases, and accounts for approximately 1% of all TB cases. Definitive diagnosis of tuberculous meningitis (TBM) depends upon the detection of the tubercle bacilli in the CSF. Every patient with TBM should preferably be evaluated by imaging with contrast enhanced CT either before or within the first 48 hours of treatment. An extra-neural focus of tuberculosis should be sought clinically and radiologically in all patients with CNS TB as it may indicate safer and more accessible sites for diagnostic samplings. A minimum of 10 months treatment is warranted, prompted by the uncertain influences of disease severity, CNS drug penetration, undetected drug resistance and patient compliance. All patients with TB meningitis may receive adjunctive corticosteroids at presentation regardless of disease severity even for those with HIV infection. Drug resistance is strongly associated with previous treatment. The key principle of managing drug-resistant TB is never to add a single drug to a failing regimen. Early ventriculo-peritoneal shunting should be considered in those with hydrocephalus failing medical management. The single most important determinant of outcome is the stage of tuberculous meningitis at which treatment has been started.
  • Item
    Eating epilepsy revisited- an electro-clinico-radiological study
    (JOURNAL OF CLINICAL NEUROSCIENCE, 2016) Jagtap, S; Menon, R; Cherian, A; Baheti, N; Ashalatha, R; Thomas, SV
    This study aimed to evaluate the clinical, video electroencephalographic and MRI attributes of patients with eating epilepsy (EE). Consecutive patients who were diagnosed with EE and underwent potential pre-surgical work-up from 2003 to 2012 formed the study cohort. Their electro-clinico-radiological and seizure outcome data were obtained from our prospectively maintained medical records. Out of 7094 patients who underwent evaluation for refractory seizures, 47 patients satisfied the criteria for EE. Twenty-three (48.9%) had exclusive EE; the remainder had a combination of predominantly eating induced and unprovoked seizures with no differences noted in timing of seizures in relation to meals. Lesional epilepsy was seen in 34% of patients, with posterior cortex (PC; posterior temporo-parietooccipital) predominance. In MRI negative patients, PC interictal epileptiform discharges were present in 34.4% of patients and multifocal in 20.6% of patients compared to the MRI positive group with 12.5% and 6.5%, respectively (p = 0.003). Among 24 patients (51.1%) with co-existent unprovoked seizures, developmental delay and PC ictal onset was more prevalent (p = 0.013 and 0.029) as compared to exclusive EE. The seizure frequency and outcome did not significantly differ between patients with or without MRI abnormality. Two patients underwent anterior temporal lobectomy, with persistence of their eating seizures postoperatively. EE is a complex reflex epilepsy of cryptogenic and symptomatic etiology. As opposed to the traditionally implied temporo-limbic mechanisms behind epileptogenesis, a multilobar network originating from the PC receiving sensory and visual inputs linked to the limbicopercular pathways represents a plausible mechanism. Surgical selection should be diligent and cautious in this group of patients. (C) 2016 Elsevier Ltd. All rights reserved.
  • Item
    Hemispheric intracranial lipoma with seizure: Look under the carpet
    (NEUROLOGY INDIA, 2011) Cherian, A; Baheti, NN; Menon, R; Iyer, RS
  • Item
    Intracerebral hemorrhages in Vogt-Koyanagi-Harada disease
    (NEUROLOGY INDIA, 2009) Baheti, NN; Cherian, A; Kate, M; Krishnan, S; Thomas, B
  • Item
    Low seroprevalence of systemic cysticercosis among patients with epilepsy in Kerala - South India
    (JOURNAL OF INFECTION AND PUBLIC HEALTH, 2014) Cherian, A; Syam, UK; Sreevidya, D; Jayaraman, T; Oommen, A; Rajshekhar, V; Radhakrishnan, K; Thomas, SV
    Purpose: Neurocysticercosis (NCC) is considered to be rare in Kerala state, India, although it is an important cause of epilepsy in many other parts of India. Our objective was to test this notion by determining the seroprevalence of cysticercosis (CC) in an unselected sample of persons with epilepsy and comparing it to that of persons without epilepsy living in Kerala. Methods: Individuals with active epilepsy (AE) who had never resided outside Kerala state for more than one month and were attending our center for epilepsy care constituted the cases. Sex-matched persons without epilepsy who had never resided outside Kerala state for more than one month constituted the controls. The demographic details, occupation, and food habits (for the cases and controls), as well as clinical characteristics and imaging (for cases only) were recorded. Sera separated from blood drawn by venipuncture from the cases and controls were assayed for cysticercal antibodies by enzyme-linked immunoelectrotransfer blot (EITB). Results: Of the 80 persons with AE, 12 were seropositive for cysticercus antibodies (15%; 95% CI: 8.8-24.4); among the 68 controls, 7 were seropositive (10.3%; 95% CI: 5.1-19.8). The odds ratio (OR) for seropositivity in the epilepsy group (1.54) was not statistically significant (95% CI: 0.6-4.2). Among the 69 patients who had a brain computed tomography (CT) scan or magnetic resonance imaging (MRI), none had features diagnostic of NCC. Gender, diet (vegetarian vs non-vegetarian, consumption of raw vegetables), drinking water status (dean vs unclean), residence (rural vs urban), exposure to manure, and animal rearing including pigs did not have any association with seropositivity. Conclusion: Among the residents of Kerala, most epilepsy is not related to cysticercosis. (C) 2014 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. AR rights reserved.
  • Item
    Lower Incidence of Neurocysticercosis among Persons with Active Epilepsy in Kerala, South India - A Case-Control Study
    (NEUROLOGY, 2013) Syam, UK; Cherian, A; Thomas, S; Radhakrishnan, K; Rajashekhar, V; Oommen, A
  • Item
    Nocardial brain abscess in an immunocompetent individual
    (NEUROLOGY INDIA, 2011) Patil, A; Cherian, A; Iype, T; Sandeep, P
  • Item
    Oxcarbazepine induced worsening of seizures in Jeavons syndrome: Lessons learnt from an interesting presentation
    (NEUROLOGY INDIA, 2011) Menon, R; Baheti, NN; Cherian, A; Iyer, RS
  • Item
    Status epilepticus
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2009) Cherian, A; Thomas, SV
    Status epilepticus (SE) is a medical emergency associated with significant morbidity and mortality. SE is defined as a continuous seizure lasting more than 30 min, or two or more seizures without full recovery of consciousness between any of them. Based on recent understanding of the pathophysiology, it is now considered that any seizure that lasts more than 5 min probably needs to be treated as SE. GABAergic mechanisms play a crucial role in terminating seizures. When the seizure persists, GABA-mediated mechanisms become ineffective and several other putative mechanisms of seizure suppression have been recognized. Early treatment of SE with benzodiazepines, followed if necessary by fosphenytoin administration, is the most widely followed strategy. About a third of patients with SE may have persistent seizures refractory to the first-line medications. They require aggressive management with second-line medications such as barbiturates, propofol, or other agents. In developing countries where facilities for assisted ventilation are not readily available, it may be helpful to use nonsedating antiepileptic drugs (such as sodium valproate, levetiracetam, or topiramate) at this stage. It is important to recognize SE and institute treatment as early as possible in order to avoid a refractory state. It is equally important to attend to the general condition of the patient and to ensure that the patient is hemodynamically stable. This article reviews current knowledge regarding the management of convulsive SE in adults.
  • Item
    Surgery for "Long-term epilepsy associated tumors (LEATs)": Seizure outcome and its predictors
    (Clin Neurol Neurosurg, 2016-02) Radhakrishnan, A; Abraham, M; Vilanilam, G; Menon, R; Menon, D; Kumar, H; Cherian, A; Radhakrishnan, N; Kesavadas, C; Thomas, B; Sarma, SP; Thomas, SV
    Objectives: “Long-term epilepsy associated tumors (LEATs)” by definition are tumors primarily causing drug-resistant seizures for two years or more. They include low-grade glial and glioneuronal tumors with normal life expectancy. We studied a large cohort of patients with LEATs who underwent surgery through our epilepsy program. Patients & methods: From 1998–2011, 105 patients with LEATs underwent surgery in our center. We utilized their data archived in a prospective registry to evaluate their electro-clinical-imaging characteristics affecting the long-term seizure outcome. Results: Of 105patients (age 3–50 years),meanage at surgery was 20 years andmeanpre-surgicalduration of epilepsy was 10.9 years. 66 (62.8%) had secondary generalized seizures. 82 had temporal tumors, 23 had extra temporal (13 frontal, 3 parietal, 2 occipital and 5 multilobar lesions) and four had associated hippocampal sclerosis. The interictal discharges and ictal onset were concordant to the lesion in 82 (78%) and 98 (93%) patients respectively. Lesionectomy and/or adjoining corticectomy or temporal lobectomy was done. Ganglioglioma was the most dominant pathological substrate in 61 (58%). During a mean follow-up of 7.5 years (range 3–16 years), 78/105 (74.2%) were seizure-free and 45 (57.4%) were totally off drugs. Secondary generalized seizures (p-0.02), temporal location of tumor (p-0.008) and spikes in third month post-operative EEG (p-0.03) caused unfavorable seizure outcome. A pre-surgical duration of epilepsy of more than 6.6 years caused less than optimal surgical outcome Conclusions: Early surgery should be considered a priority in LEATs. Presence of secondary generalized seizures is the single most important predictor of a poor seizure outcome