Browsing by Author "Rathore, C"

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    Acquired hepatolenticular degeneration: Is the T1 hyperintensity due to manganese deposition?
    (NEUROLOGY INDIA, 2009) Baheti, NN; Hassan, H; Rathore, C; Krishnan, S; Kesavadas, C
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    Antiepileptic drugs for the primary and secondary prevention of seizures in viral encephalitis
    (COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2016) Pandey, S; Rathore, C; Michael, BD
    Background Viral encephalitis is characterised by diverse clinical and epidemiological features. Seizures are an important clinical manifestation and are associated with increased mortality and morbidity. Patients may have seizures during the acute illness or they may develop after recovery. There are no recommendations regarding the use of antiepileptic drugs for the primary or secondary prevention of seizures in patients with viral encephalitis. This is an updated version of the original Cochrane review published in The Cochrane Library 2014, Issue 10. Objectives To assess the efficacy and tolerability of antiepileptic drugs for the primary and secondary prophylaxis of seizures in viral encephalitis. We had intended to answer the following questions. 1. Do antiepileptic drugs used routinely as primary prophylaxis for all patients with suspected or proven viral encephalitis reduce the risk of seizures during the acute illness and reduce neurological morbidity and mortality? 2. Do antiepileptic drugs used routinely as secondary prophylaxis for all patients who have had at least one seizure due to suspected or proven viral encephalitis reduce the risk of further seizures during the acute illness and reduce neurological morbidity and mortality? Search methods For the latest version of this review, we searched the Cochrane Epilepsy Group Specialized Register (11 April 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online (CRSO, 11 April 2016), MEDLINE (Ovid 1946 to 11 April 2016), the WHO International Clinical Trials Registry Platform (ICTRP, 11 April 2016), and ClinicalTrials.gov (11 April 2016). We did not impose any language restrictions. Selection criteria Randomised and quasi-randomised controlled trials in which patients were assigned to a treatment or control group (placebo or no drug). Data collection and analysis One review author (SP) searched the publications by title, abstract and keywords, and decided on their suitability for the review. For any studies where their suitability was unclear, the co-authors (CR, BM) were consulted. The co-authors (CR, BM) independently evaluated the selected studies. Since there were no included studies, we carried out no data analysis. Main results We did not find any randomised or quasi-randomised controlled trials that compared the effects of antiepileptic drugs with placebo (or no drug) for the primary or secondary prevention of seizures in viral encephalitis. We identified two studies from the literature search where different antiepileptic drugs were used in patients with viral encephalitis, however both failed to meet the inclusion criteria. Authors' conclusions There is insufficient evidence to support or refute the routine use of antiepileptic drugs for the primary or secondary prevention of seizures in viral encephalitis. There is a need for adequately powered randomised controlled trials in patients with viral encephalitis to assess the efficacy and tolerability of antiepileptic drugs for the primary and secondary prophylaxis of seizures, which is an important clinical problem.
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    Antiepileptic drugs for the primary and secondary prevention of seizures in viral encephalitis
    (COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2014) Pandey, S; Rathore, C; Michael, BD
    Background Viral encephalitis is characterised by diverse clinical and epidemiological features. Seizures are an important clinical manifestation and associated with increased mortality and morbidity. Patients may have seizures during the acute illness or they may develop after recovery. There are no recommendations regarding the use of antiepileptic drugs for the primary or secondary prevention of seizures in patients with viral encephalitis. Objectives To assess the efficacy and safety of antiepileptic drugs for the primary and secondary prophylaxis of seizures in viral encephalitis. We intended to answer the following questions. 1. Do antiepileptic drugs used as primary prophylaxis routinely for all patients with suspected or proven viral encephalitis reduce the risk of seizures during the acute illness and reduce neurological morbidity and mortality? 2. Do antiepileptic drugs used as secondary prophylaxis routinely for all patients who have had at least one seizure due to suspected or proven viral encephalitis reduce the risk of further seizures during the acute illness and reduce neurological morbidity and mortality? Search methods We searched the Cochrane Epilepsy Group Specialised Register (13 May 2014), the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 4) (April 2014), MEDLINE (Ovid, 1946 to 13 May 2014), the WHO ICTRP search portal (13 May 2014) and ClinicalTrials.gov (13 May 2014). We did not impose any language restrictions. Selection criteria Randomised and quasi-randomised controlled trials in which patients were assigned to a treatment or control group (placebo or no drug). Data collection and analysis One author (SP) searched the publications by title, abstract and keywords and decided on their suitability for inclusion in the review. For any studies where it was unclear whether they would be suitable for inclusion, the co-authors (CR, BM) were consulted. The coauthors (CR, BM) evaluated the selected studies independently. Since there were no included studies, we carried out no data analysis. Main results We did not find any randomised or quasi-randomised controlled trials that compared the effects of antiepileptic drugs with placebo (or no drug) for the primary or secondary prevention of seizures in viral encephalitis. We identified two studies from the literature search where different antiepileptic drugs were used in patients with viral encephalitis, however both failed to meet the inclusion criteria. The first study included children with viral encephalitis where antiepileptic drugs were given. However, it is not clear how the diagnosis was established or the aetiologies. In addition, the randomisation and blinding method is not disclosed; the patients received a diverse and ill-defined range of antiepileptic drugs and adjunctive therapies, and none of the primary or secondary outcome measures was assessed. In the second study, adults with status epilepticus (of whom a proportion had viral encephalitis), who had failed to respond to two initial boluses of diazepam, were randomised to either valproate or diazepam. The study was open-label and the randomisation methodology was not disclosed; none of the primary or secondary outcomes were reported. Data on treatment response between the two arms for those patients with viral encephalitis are not presented for subgroup analysis; the Cochrane Epilepsy Group have contacted the authors for these data but have yet to receive a response. Authors' conclusions There is insufficient evidence to support the routine use of antiepileptic drugs for the primary or secondary prevention of seizures in viral encephalitis. There is a need for adequately powered randomised controlled trials in viral encephalitis patients to assess the efficacy and safety of antiepileptic drugs for the primary and secondary prophylaxis of seizures, which is an important clinical problem.
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    Calcified neurocysticercosis lesions and antiepileptic drug-resistant epilepsy: A surgically remediable syndrome?
    (EPILEPSIA, 2013) Rathore, C; Thomas, B; Kesavadas, C; Abraham, M; Radhakrishnan, K
    PurposeIn contrast to the well-recognized association between acute symptomatic seizures and neurocysticercosis, the association between antiepileptic drug (AED)-resistant epilepsy and calcified neurocysticercosis lesions (CNLs) is poorly understood. We studied the association between AED-resistant epilepsy and CNLs, including the feasibility and outcome of resective surgery. MethodsFrom the prospective database maintained at our epilepsy center, we reviewed the data of all patients with AED-resistant epilepsy who underwent presurgical evaluation from January 2001 to July 2010 and had CNL on imaging. We used clinical, neuroimaging, and interictal, ictal, and intracranial electroencephalography (EEG) findings to determine the association between CNL and epilepsy. Suitable candidates underwent resective surgery. Key FindingsForty-five patients fulfilled the inclusion criteria. In 17 patients, CNL was proven to be the causative lesion for AED-resistant epilepsy (group 1); in 18 patients, CNL was associated with unilateral hippocampal sclerosis (HS; group 2); and in 10 patients, CNLs were considered as incidental lesions (group 3). In group 1 patients, CNLs were more common in frontal lobes (12/17), whereas in group 2 patients, CNLs were more commonly located in temporal lobes (11/18; p=0.002). Group 2 patients were of a younger age at epilepsy onset than those in group 1 (8.97.3 vs. 12.6 +/- 6.8years, p=0.003). Perilesional gliosis was more common among patients in group 1 when compared to group 3 patients (12/17 vs. 1/10; p=0.006). Fifteen patients underwent resective surgery. Among group 1 patients, four of five became seizure-free following lesionectomy alone. In group 2, four patients underwent anterior temporal lobectomy (ATL) alone, of whom one became seizure-free; five underwent ATL combined with removal of CNL (two of them after intracranial EEG and all of them became seizure-free, whereas one patient underwent lesionectomy alone and did not become seizure-free. SignificanceIn endemic regions, although rare, CNLs are potential cause for AED-resistant and surgically remediable epilepsy, as well as dual pathology. Presence of perilesional gliosis contributes to epileptogenicity of these lesions. For those patients with CNL and HS, resection of both lesions favors better chance of seizure-free outcome.
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    CALCIFIED NEUROCYSTICERCUS LESIONS (CNL) AND DRUG RESISTANT EPILEPSY: SURGICALLY REMEDIABLE SYNDROME?
    (EPILEPSIA, 2013) Rathore, C; Thomas, B; Kesavadas, C; Abraham, M; Radhakrishnan, K
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    Calcified Neurocysticercus Lesions and Hippocampal Sclerosis: Potential Dual Pathology?
    (NEUROLOGY, 2012) Radhakrishnan, K; Rathore, C; Thomas, B; Kesavadas, C
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    Concept of epilepsy surgery and presurgical evaluation
    (EPILEPTIC DISORDERS, 2015) Rathore, C; Radhakrishnan, K
    Epilepsy surgery is a well-accepted treatment for drug-resistant epilepsy. The success of the epilepsy surgery depends upon an appropriate presurgical evaluation process which should ensure the selection of suitable patients who are likely to become seizure-free following surgery without any unacceptable deficit. The two basic goals of the presurgical evaluation are the accurate localization and delineation of the extent of the epileptogenic zone, and its complete and safe resection. The process of the presurgical evaluation requires a multimodality approach wherein each modality provides unique and complimentary information which is combined with the information provided by other modalities to generate a hypothesis with regard to the likely epileptogenic zone. The basic modalities for the presurgical evaluation are clinical history, long-term video-EEG recording, high-resolution MRI, and neuropsychological evaluation. The additional modalities include functional imaging studies, electrical and magnetic source imaging, functional MRI, and intracranial monitoring. Each modality has its own limitations and the information provided by none of them is absolute. Hence, a concordance among the different modalities is the key to surgical success. The presurgical evaluation is a step-wise process starting form the most basic and most reliable tests and progressing to more complex and invasive modalities. The number of tests required varies according to the complexity involved and may include very basic minimum investigations in a given case, to the use of all the available investigations in more complex cases. The proper selection of various investigations and their accurate interpretation at each stage is required to ensure a successful outcome. In this article, we intend to review some of these basic concepts of presurgical evaluation and epilepsy surgery, and try to provide a frame work of the presurgical evaluation process.
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    Cost-effective utilization of SPECT for the presurgical evaluation of refractory epilepsy
    (JOURNAL OF THE NEUROLOGICAL SCIENCES, 2009) Rathore, C; Radhakrishnan, A; Kesavdas, C; Sarma, PS; Radhakrishnan, K
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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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    DOES ACUTE ELECTROCORTICOGRAPHY PREDICTS SEIZURE OUTCOME FOLLOWING ANTERIOR TEMPORAL LOBECTOMY?
    (EPILEPSIA, 2009) Rekalakunta, C; Rathore, C; Nayak, D; Abraham, M; Radhakrishnan, A; Radhakrishnan, K
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    DOES HIPPOCAMPUS PLAY ANY ROLE IN DETERMINING LANGUAGE LATERALIZATION?
    (EPILEPSIA, 2009) Rathore, C; George, A; Sarma, P; Radhakrishnan, K
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    LATERALIZING VALUE OF TEMPORAL NEOCORTICAL APPARENT DIFFUSION CO-EFFICIENT (ADC) AND T2 RELAXOMETRY VALUES IN MESIAL TEMPORAL LOBE EPILEPSY WITH HIPPOCAMPAL SCLEROSIS
    (EPILEPSIA, 2013) Hingwala, D; Rathore, C; Jagtap, S; Gautam, N; Abraham, J; Kesavadas, C; Radhakrishnan, K
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    Memory outcome following left anterior temporal lobectomy in patients with a failed Wada test
    (EPILEPSY & BEHAVIOR, 2015) Rathore, C; Alexander, A; Sarma, PS; Radhakrishnan, K
    Purpose: This study aimed to compare the memory outcome following left anterior temporal lobectomy (ATL) between patients with a failed Wada test and patients who passed the Wada test. Methods: From 1996 to 2002, we performed the Wada test on all patients with unilateral left mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) and concordant electroclinical data before ATL. We used a 12-item recognition paradigm for memory testing and awarded a score of + 1 for each correct response and -0.5 for each incorrect response. No patient was denied surgery on the basis ofWada scores. We assessed cognitive and memory functions using the Wechsler Adult Intelligence Scale and the Wechsler Memory Scale preoperatively and at one year after ATL. We compared the number of patients who showed decline in memory scores, as per the published reliable change indices, between the patients with a failed Wada test and the patients who passed the Wada test. Results: Out of the 116 eligible patients with left MTLE-HS, 88 underwent bilateral Wada test, while 28 underwent ipsilateral Wada test. None of them developed postoperative amnesia. Approximately, one-third of patients with a failed Wada memory test when the failure was defined as a contralateral score of <4, as an ipsilateral score of >8, and as an asymmetry score of <0. The patients with Wada memory failure had a longer pre-ATL duration of epilepsy (p < 0.003). The memory and quality-of-life outcomes did not differ between the group with a failed Wada memory test and the group who passed the Wada memory test. The results remained the same when analyses were repeated at various other cutoff points. Conclusion: The patients with left MTLE-HS with concordant electroclinical, MRI, and neuropsychological data should not be denied ATL solely on the basis of Wada memory test results. (C) 2015 Elsevier Inc. All rights reserved.
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    National epilepsy surgery program: Realistic goals and pragmatic solutions
    (NEUROLOGY INDIA, 2014) Rathore, C; Rao, MB; Radhakrishnan, K
    There are multiple social, economic, and medical challenges in establishing successful epilepsy surgery programs in India and in other low- and middle-income countries (LAMIC). These can be overcome by reproducing pragmatic and proven epilepsy surgery models throughout the country with a larger aim of developing a national epilepsy surgery program so as to provide affordable and quality surgical care to all the deserving patients. An organized national epilepsy surgery support activity can help interested centers in India and in neighboring countries in developing epilepsy surgery programs.
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    National Epilepsy Surgery Support Activity
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2014) Radhakrishnan, K; Rathore, C; Rao, MB
    While there are over one million people with drug-resistant epilepsy in India, today, there are only a handful of centers equipped to undertake presurgical evaluation and epilepsy surgery. The only solution to overcome this large surgical treatment gap is to establish comprehensive epilepsy care centers across the country that are capable of evaluating and selecting the patients for epilepsy surgery with the locally available technology and in a cost-effective manner. The National Epilepsy Surgery Support Activity (NESSA) aims to provide proper guidance and support in establishing epilepsy surgery programs across India and in neighboring resource-poor countries, and in sustaining them.
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    PREDICTORS OF SEIZURE OUTCOME FOLLOWING RESECTIVE SURGERY FOR DRUG RESISTANT EPILEPSY ASSOCIATED WITH FOCAL GLIOSIS
    (EPILEPSIA, 2011) Dash, GK; Rathore, C; Jeyaraj, KM; Radhakrishnan, K
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    Primary angiitis of central nervous system: Tumor-like lesion
    (NEUROLOGY INDIA, 2010) Kumar, RS; Singh, A; Rathore, C; Kesavadas, C
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    Prophylactic antiepileptic drugs in brain tumors: What evidence is enough evidence?
    (Neurol India, 2013-05) Rathore, C; Radhakrishnan, K
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    Reversible photoparoxysmal response at 1 Hz in a patient with posterior fossa mass lesion
    (NEUROLOGY INDIA, 2010) Dash, GK; Kate, MP; Rathore, C; Radhakrishnan, A