Browsing by Author "Menon, R"

Now showing 1 - 14 of 14
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    A pilot study on utility of Malayalam version of Addenbrooke's Cognitive Examination in detection of amnestic mild cognitive impairment: A critical insight into utility of learning and recall measures
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2014) Menon, R; Lekha, VS; Justus, S; Sarma, PS; Mathuranath, PS
    Aims: This pilot study sought to determine whether the Malayalam adaptation of Addenbrooke's Cognitive Examination (M-ACE) can effectively identify patients with amnestic mild cognitive impairment (a-MCI) and the impact of measures of learning and free recall. Materials and Methods: A cohort of 23 patients with a-MCI aged between 55-80 years diagnosed as per current criteria and 23 group matched cognitively normal healthy controls (CNHC) were studied. The measures of acquisition and delayed recall were the Rey Auditory Verbal Learning Test (RAVLT) and Wechsler Memory Scale (WMS)-III (verbal and visual subsets) and Delayed Matching-to-sample Test (DMS)-48. Test scores of M-ACE registration and recall scores were included. To examine the differences in test performances between the groups, we compared the number of subjects with test scores less than 1.5 standard deviation (SD) of the control scores. Comparisons between a-MCI and controls were drawn using Fisher's exact test and Mann-Whitney U tests. Results: M-ACE registration component ascertained on a 24-point scale failed to demonstrate any differences between a-MCI and controls (P = 0.665) as opposed to recall judged on a cumulative 10-point scale (P = 0.001). Significant differences were noted in RAVLT list learning (P < 0.001) and list recall (P = 0.003), WMS-III paragraph learning (P < 0.001) and recall (P = 0.007), visual learning (P = 0.004) and recall (P = 0.001). Conclusions: M-ACE recall scores are an effective screening tool to identify patients with suspected a-MCI. Both word list and paragraph learning and recall components have been found to be sensitive to concretely identify a-MCI and impairment on at least 2 tests should be considered in the diagnostic criteria of MCI rather than rely on a single screening battery.
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    An audit of the predictors of outcome in status epilepticus from a resource-poor country: a comparison with developed countries
    (EPILEPTIC DISORDERS, 2016) Hassan, H; Rajiv, KR; Menon, R; Menon, D; Nair, M; Radhakrishnan, A
    Aim. Status epilepticus is a neurological emergency with significant morbidity and mortality. This study describes the clinical profile, treatment, and predictors of outcome of status epilepticus in a tertiary referral centre in a developing country and aims to highlight the similarities and differences from data available from the western world. Methods. A retrospective analysis of data of patients treated for status epilepticus was conducted from prospectively maintained records, between January 2000 and September 2010. The demographic data, clinical profile and investigations (including neuroimaging and EEG), aetiology, treatment, and outcomes were studied and compared with data available from the western world. Results. The analysis included 108 events in 84 patients. A single episode of status epilepticus was treated in 72 patients (86%) and multiple status epilepticus events, ranging from two to six per patient, were managed in 12 patients (14%). Mean age was 24.1 +/- 20.3 years and 63% were males. The types of status epilepticus included convulsive status in 98 (90.7%), non-convulsive status in seven (6.5%), and myoclonic status in three (2.8%). The majority of events (60%) were remote symptomatic, 16% were acute symptomatic, 16% were of unexplained aetiology, and 8% were progressive symptomatic. In 85 events (79%), status epilepticus could be aborted with first and second-line drugs. The remaining 23 events (21%) progressed to refractory status epilepticus, among which, 13 (56%) were controlled with continuous intravenous midazolam infusion. Case fatality rate was 11%, neurological sequelae were reported in 22%, and 67% returned to baseline. Acute symptomatic status, older age, altered sensorium at the time of admission, and delayed hospitalisation were predictors of poor outcome. Conclusions. Aetiologywas the most important determinant of outcome of status epilepticus, as in reports from the western world, with remote symptomatic aetiology secondary to gliosis being the most common. Treatment delay was frequent and adversely affected the outcome.
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    Diffusion tensor imaging tractography of Meyer's loop in planning resective surgery for drug-resistant temporal lobe epilepsy
    (EPILEPSY RESEARCH, 2015) James, JS; Radhakrishnan, A; Thomas, B; Madhusoodanan, M; Kesavadas, C; Abraham, M; Menon, R; Rathore, C; Vilanilam, G
    Purpose: Whether Meyer's loop (ML) tracking using diffusion tensor imaging tractography (DTIT) can be utilized to avoid post-operative visual field deficits (VFD) after anterior temporal lobectomy (ATL) for drug-resistant temporal lobe epilepsy (TLE) using a large cohort of controls and patients. Also, we wanted to create a normative atlas of ML in normal population. Methods: DTIT was used to study ML in 75 healthy subjects and 25 patients with and without VFD following ATL. 1.5T MRI echo-planar DTI sequences with DTI data were processed in Nordic ICE using a probabilistic method; a multiple region of interest technique was used for reconstruction of optic radiation trajectory. Visual fields were assessed in patients pre- and post-operatively. Results: Results of ANOVA showed that the left ML-TP distance was less than right across all groups (p = 0.01). The average distance of ML from left temporal pole was 37.44 +/- 4.7 mm (range: 32.2-46.6 mm) and from right temporal pole 39.08 +/- 4.9 mm (range: 34.3-49.7 mm). Average distance of left and right temporal pole to tip of temporal horn was 28.32 +/- 2.03 mm (range: 26.4-32.8 mm) and was 28.92 +/- 2.09 mm, respectively (range: 25.9-33.3 mm). If the anterior limit of the Meyer's loop was <= 38 mm on the right and <= 35 mm on the left from the temporal pole, they are at a greater risk of developing VFDs. Conclusions: DTIT is a novel technique to delineate ML and plays an important role in planning surgical resection in TLE to predict post-operative visual performance and disability. (C) 2014 Elsevier B.V. All rights reserved.
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    Early resective surgery causes favorable seizure outcome in malformations of cortical development
    (EPILEPSY RESEARCH, 2016) Radhakrishnan, A; Menon, R; Menon, D; Singh, A; Radhakrishnan, N; Vilanilam, G; Abraham, M; Thomas, B; Kesavadas, C; Varma, RP; Thomas, SV
    Purpose: We analyzed consecutive cases of a large cohort of the spectrum of malformations of cortical development (MCDs) including focal cortical dysplasias (FCDs) who underwent presurgical evaluation through our epilepsy program from January 2000-December 2010. We analyzed factors predicting surgical candidacy, predictors of seizure outcome and reasons for deferring surgery. Methods: 148 patients with MCD underwent detailed presurgical evaluation and 69 were operated. MCD was diagnosed based on characteristic findings in MRI and re-confirmation by histopathology in operated patients. Post-operative seizure outcome of non-operated and operated patients were assessed every 3 and 12 months and yearly intervals. Multivariate analysis and backward step-wise logistic regression analyzed factors predicting seizure outcome. Kaplan-Meier analysis predicted seizure-free survival rates. Results: 66.67% patients were seizure-free and aura-free at last follow-up. On multivariate logistic regression, the predictors of seizure freedom in operated MCDs were completeness of resection (odds ratio 8.2; 95% CI 1.43-64.96, p = 0.01), shorter duration of epilepsy (odds ratio 1.19, 95% CI 1.02-1.39, p = 0.02), and absence of spikes in post-operative EEG at one year (odds ratio 4.2; 95% CI 2.52-16.6; p <0.002). In FCD sub-group, shorter duration of epilepsy (11.1 versus 16.1 years, p = 0.03), absence of secondary generalized seizures (p = 0.05), absence of spikes in post-operative EEG on seventh day (p = 0.009) and one year (p = 0.002) were associated with favorable seizure outcome. Conclusion: Majority of patients with MCD and refractory epilepsy when operated early remains seizure free. Shorter duration of epilepsy is the single most important pre-operative variable and absence of spikes in post-operative EEG, predicts a long-term favorable seizure outcome. (c) 2016 Elsevier B.V. All rights reserved.
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    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.
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    ELECTROCLINICAL PREDICTORS OF OUTCOME IN WEST SYNDROME & ITS RELATIONSHIP TO TRACTOGRAPHIC ABNORMALITIES
    (EPILEPSIA, 2015) Menon, R; Sundar, A; Nair, JS; Radhakrishnan, A; Thomas, B; Thomas, S
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    Hemispheric intracranial lipoma with seizure: Look under the carpet
    (NEUROLOGY INDIA, 2011) Cherian, A; Baheti, NN; Menon, R; Iyer, RS
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    Incidence of Alzheimer's disease in India: A 10 years follow-up study
    (Neurol India, 2012-12) Mathuranath, PS; George, A; Ranjith, N; Justus, S; Kumar, MS; Menon, R; Sarma, PS; Verghese, J
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    MAPPING AND VOLUMETRY OF HESCHL'S GYRUS BY VBM AIDS IN PLANNING TEMPORAL LOBE RESECTION IN PATIENTS WITH "TLE WITH AUDITORY AURA"
    (EPILEPSIA, 2015) Radhakrishnan, A; James, JS; Sundar, A; Thomas, B; Menon, R; Vilanilam, C; Abraham, M
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    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
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    A pilot study on utility of Malayalam version of Addenbrooke’s cognitive examination in detection of amnestic mild cognitive impairment: A critical insight into utility of learning and recall measures
    (Annals of Indian Academy of Neurology, 2014-12) Menon, R; Lekha, VS; Justus, S; Sarma, PS; Mathuranath, PS
    AIMS: This pilot study sought to determine whether the Malayalam adaptation of Addenbrooke's Cognitive Examination (M-ACE) can effectively identify patients with amnestic mild cognitive impairment (a-MCI) and the impact of measures of learning and free recall. MATERIALS AND METHODS: A cohort of 23 patients with a-MCI aged between 55-80 years diagnosed as per current criteria and 23 group matched cognitively normal healthy controls (CNHC) were studied. The measures of acquisition and delayed recall were the Rey Auditory Verbal Learning Test (RAVLT) and Wechsler Memory Scale (WMS)-III (verbal and visual subsets) and Delayed Matching-to-sample Test (DMS)-48. Test scores of M-ACE registration and recall scores were included. To examine the differences in test performances between the groups, we compared the number of subjects with test scores less than 1.5 standard deviation (SD) of the control scores. Comparisons between a-MCI and controls were drawn using Fisher's exact test and Mann-Whitney U tests. RESULTS: M-ACE registration component ascertained on a 24-point scale failed to demonstrate any differences between a-MCI and controls (P = 0.665) as opposed to recall judged on a cumulative 10-point scale (P = 0.001). Significant differences were noted in RAVLT list learning (P < 0.001) and list recall (P = 0.003), WMS-III paragraph learning (P <0.001) and recall (P = 0.007), visual learning (P = 0.004) and recall (P = 0.001). CONCLUSIONS: M-ACE recall scores are an effective screening tool to identify patients with suspected a-MCI. Both word list and paragraph learning and recall components have been found to be sensitive to concretely identify a-MCI and impairment on at least 2 tests should be considered in the diagnostic criteria of MCI rather than rely on a single screening battery.
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    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
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    VALIDATION OF NINDS-CSN HARMONISATION BATTERY FOR VASCULAR COGNITIVE IMPAIRMENT ACROSS DIFFERENT LANGUAGES, LITERACY LEVELS AND CULTURES
    (INTERNATIONAL JOURNAL OF STROKE, 2016) Alladi, S; Mekala, S; Iyer, GK; Dutt, A; Ellajosyula, R; Ghosh, A; Kandukuri, R; Mathuranath, PS; Menon, R; Narayanan, J; Nehra, A; Gollahalli, D; Shah, U; Tripathi, M; Sharma, M; Kaul, S
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    What is the standard approach to assessment of an unprovoked seizure in an adult?
    (Neurol Clin Pract, 2012-12) Radhakrishnan, K; Rathore, C; Menon, R