Browsing by Author "Sarma, S"

Now showing 1 - 20 of 22
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    ANTIPLATELETS VERSUS ANTICOAGULANTS IN EXTRACRANIAL CAROTID AND VERTEBRAL ARTERY DISSECTION
    (INTERNATIONAL JOURNAL OF STROKE, 2016) Vineetha, V; Sylaja, P; Sreedharan, S; Sarma, S
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    Clinical and electroencephalographic correlates of breach activity
    (AMERICAN JOURNAL OF ELECTRONEURODIAGNOSTIC TECHNOLOGY, 1999) Radhakrishnan, K; Chandy, D; Menon, G; Sarma, S
    In order to define the EEG spectrum and the prevalence of breach activity, as well as the factors contributing to its genesis, we studied 50 patients with surgically induced skull defects. We observed breach activity in 32 (64%) patients. Focally enhanced alpha, beta, and mu rhythms with or without decreased amplitude of eye movement artifacts were the EEG findings encountered in our patients. The amplitude asymmetry never exceeded a factor of 3 or more. Of the variables compared between patients with and without breach activity, only the time between surgery and the EEG recording correlated positively with the development of breach activity. The delay in the development of breach activity may indicate that breach activity is not due solely to the discontinuity of bone. The development of meningocortical adhesions and gliosis could contribute to the pathogenesis of breach activity.
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    Content validity of the newly developed risk assessment tool for religious mass gathering events in Indian settings (Mass Gathering Risk Assessment Tool-MGRAT).
    (J Family Med Prim Care, 2019-07) Sharma, U; Desikachari, BR; Sarma, S
    Background: Risk assessment (RA) for mass gathering events is crucial to identify potential health hazards. It aids in planning and response activities specific to the event but is often overlooked by the event organizers. This paper reports the content validity process of a newly developed tool called Mass Gathering Risk Assessment Tool (MGRAT), which intends to assess the risks associated with religious mass gathering events in Indian settings. Methods: Qualitative approach was followed to identify the risks associated with mass gathering events and to identify the domains and items to be included in the RA tool. The draft tool was shared with six experts who were selected by the convenient method; selected experts were requested to assess the tool and give their comments about the domains, items, relevant responses, and overall presentation of the tool using content validity questionnaire. Content validity index and Fleiss kappa statistics were calculated to assess the agreement between multiple raters. Results: Agreement proportion expressed as scale-level content validity index (S-CVI) calculated by the averaging method is 0.92. S-CVI; calculated by universal agreement is 0.78. Fleiss kappa statistics to measure the agreement between multiple experts after adjusting the component of the chance agreement is 0.522 (95% CI: 0.417, 0.628, P value: 0.001). Conclusion: MGRAT is a valid tool, which has an appropriate level of content validity. As the number of raters increases, there will be difficulty in achieving consensus among all the items, which is the reason for lower Content Validity Index/Universal Average (CVI/UA) when compared with Content Validity Index/Average (CVI/Ave). Fleiss kappa statistics also indicated moderate agreement among the raters beyond the chance agreement, which also supports the appropriate content validity of MGRAT.
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    Design and methodology of a community-based cluster randomized controlled trial for dietary behaviour change in rural Kerala
    (Global Health Action 2013, 2013-09) Daivadanam, D; Wahlstrom, R; Ravindran, TK; Sarma, S; Sivasankaran, S; Thankappan, KR
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    Dopamine D3 receptor Ser9Gly variant is associated with impulse control disorders in Parkinson's disease patients
    (Parkinsonism Relat Disord., 2016-12) Krishnamoorthy, S; Rajan, R; Banerjee, M; Kumar, H; Sarma, G; Krishnan, S; Sarma, S; Kishore, A
    Introduction: Impulse control disorders (ICD) are reported to occur at variable frequencies in different ethnic groups. Genetic vulnerability is suspected to underlie the individual risk for ICD. We investigated whether the allelic variants of dopamine (DRD3), glutamate (GRIN2B) and serotonin (HTR2A) receptors are linked to ICD in Indian Parkinson’s disease (PD) patients. Methods: We conducted a prospective, case-control study which included PD patients (70 with ICD, 100 without ICD categorized after direct psychiatric interview of patient and caregiver) and 285 healthy controls. Single nucleotide polymorphism (SNP) variants of DRD3 p.S9G (rs6280), GRIN2B c.2664C>T (rs1806201) and HTR2A c.102T>C (rs6313) were genotyped. Results: Multivariate regression analysis revealed that DRD3 p.Ser9Gly (rs6280) heterozygous variant CT (OR ¼ 2.22, 95% CI: 1.03e4.86, p ¼ 0.041), higher daily Levodopa equivalent doses (LED) of drugs (for 100 mg LED, OR ¼ 1.14, 95% CI: 1.01e1.29, p ¼ 0.041), current dopamine agonist but not Levodopa use (OR ¼ 2.16, 95% CI: 1.03e4.55, p ¼ 0.042) and age of onset of motor symptoms under 50 years (OR 2.09, 95% CI: 1.05e4.18, p ¼ 0.035) were independently associated with ICD. Conclusion: DRD3 p.Ser9Gly (rs6280) CT genotype is associated with ICD in Indian PD patients and this association is novel. Enhanced D3 receptor affinity due to gain-of-function conferred by the glycine residues could impair reward-risk assessment in the mesolimbic system and contribute to development of impulsive behaviour, in carriers of this genotype.
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    Early risk and predictors of cerebrovascular and cardiovascular events in transient ischemic attack and minor ischemic stroke
    (NEUROLOGY INDIA, 2012) Kate, M; Sylaja, PN; Chandrasekharan, K; Balakrishnan, R; Sarma, S; Pandian, JD
    Background: Transient ischemic attack (TIA) and minor ischemic stroke (MIS) are associated with early recurrence and deterioration respectively. The aim of the present study was to assess the risk of new cerebrovascular and cardiovascular events in a prospective, emergently enrolled patient cohort with TIA and MIS and the predictors of risk. Materials and Methods: Patients with TIA and MIS (NIH Stroke Scale [NIHSS] <= 5) presenting within the first 48 h between July 2008-June 2009 were prospectively enrolled. The primary outcome was new-onset stroke, TIA, cardiovascular events and vascular death at 90 days and early deterioration in patients with minor stroke. The 90-day outcome was also assessed (excellent outcome; modified Rankin scale [mRS] <= 2). Results: Eighteen (15.3%) of the 118 patients enrolled developed new cerebrovascular or cardiovascular events during the 90 days of follow-up, nine (50%) of which occurred within seven days. Of the all new events 5.9% (7/118) had new stroke, 4.2% (5/118) patients developed early deterioration, 2.5% (3/118) patients had recurrent TIA and 2.5% (3/118) had cardiovascular events at 90 days. Eight (6.7%) patients had poor outcome at 90 days (mRS>2). The factors predicting new vascular events were presence of coronary artery disease (CAD), and stroke etiology being large artery atherosclerosis (LAA). Conclusion: In patients with TIA and MIS, despite urgent evaluation and aggressive management, the short-term risk of stroke and other vascular events is high. Those with CAD and LAA should be monitored closely for early deterioration.
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    Electrode Position and Current Amplitude Modulate Impulsivity after Subthalamic Stimulation in Parkinsons Disease-A Computational Study
    (FRONTIERS IN PHYSIOLOGY, 2016) Mandali, A; Chakravarthy, VS; Rajan, R; Sarma, S; Kishore, A
    Background: Subthalamic Nucleus Deep Brain Stimulation (SIN-DES) is highly effective in alleviating motor symptoms of Parkinson's disease (PD) which are not optimally controlled by dopamine replacement therapy. Clinical studies and reports suggest that STN-DBS may result in increased impulsivity and de novo impulse control disorders (ICD). Objective/Hypothesis: We aimed to compare performance on a decision making task, the Iowa Gambling Task (IGT), in healthy conditions (HC), untreated and medically-treated PD conditions with and without STN stimulation. We hypothesized that the position of electrode and stimulation current modulate impulsivity after STN-DBS. Methods: We built a computational spiking network model of basal ganglia (BG) and compared the model's STN output with STN activity in PD. Reinforcement learning methodology was applied to simulate IGT performance under various conditions of dopaminergic and STN stimulation where IGT total and bin scores were compared among various conditions. Results: The computational model reproduced neural activity observed in normal and PD conditions. Untreated and medically-treated PD conditions had lower total IGT scores (higher impulsivity) compared to HC (P < 0.0001). The electrode position that happens to selectively stimulate the part of the STN corresponding to an advantageous panel on IGT resulted in de-selection of that panel and worsening of performance (P < 0.0001). Supratherapeutic stimulation amplitudes also worsened IGT performance (P < 0.001). Conclusion(s): In our computational model, STN stimulation led to impulsive decision making in IGT in PD condition. Electrode position and stimulation current influenced impulsivity which may explain the variable effects of STN-DBS reported in patients.
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    Employment status, social function decline and caregiver burden among stroke survivors. A South Indian study
    (JOURNAL OF THE NEUROLOGICAL SCIENCES, 2013) Sreedharan, SE; Unnikrishnan, JP; Amal, MG; Shibi, BS; Sarma, S; Sylaja, PN
    Stroke leaves at least 60% of the survivors with moderate to severe disability limiting their employment status and social functioning leading to high levels of caregiver burden. Aim: We sought to study the employment status and level of change of social functioning of stroke survivors and their principal caregiver and correlate it with severity of stroke, functional disability, and anxiety and depression scores. Methods: One hundred and fifty stroke survivors and principal caregivers (3 months-2 years post-stroke) were recruited for the study. The employment status pre- and post-stroke was assessed. The social function of the patient and caregiver was analyzed using a 6 item social function scale developed for the study, encompassing culturally relevant questions. A 20 point scale adapted from Burden assessment schedule was used to assess the caregiver burden. Results: Mean age of the study group was 54.37 +/- 12.072 (range 22-75 years), with 116 males and 34 females. Spouse was the principal caregiver for 142/150 patients (94.6%). In the stroke survivors, compared to the pre-stroke employment status of 62.7%, only 20.7% were employed post-stroke with half having change of job. But the employment status of caregiver was not reduced post-stroke (34.7% vs 33.3%). Employment loss in stroke survivors had a statistically significant association with severity of functional disability, male gender and presence of limb weakness (p values 0.037, 0.0001 and 0.043 respectively). There was an overall decline in social functions among the 6 parameters assessed in both the stroke survivors and caregivers. Of the caregiver burden, financial burden was more among female and older caregivers. The functional status and motor weakness of the stroke survivors did not tend to worsen the overall caregiver burden. Conclusions: Loss of occupation among stroke survivors is high. The decline in social function among stroke survivors and caregivers was significant. Even though functional disability contributed to employment loss and social function decline among stroke survivors, it did not have a significant impact on caregiver burden. (C) 2013 Elsevier B.V. All rights reserved.
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    Evidence of functional somatotopy in GPi from results of pallidotomy
    (BRAIN, 2000)
    The objective of this study was to explore the functional anatomy of the globus pallidus internus (GPi) by studying the effects of unilateral pallidotomy on parkinsonian 'off' signs and levodopa-induced dyskinesias (LID), We found significant positive! correlations between the preoperative levodopa responsiveness of motor signs and the levodopa responsiveness of scores in timed tests (Core Assessment Program for Intracerebral Transplantations) in the contralateral limbs and the improvement in these scores after surgery, whereas there was no correlation with the improvement in LID, We also found a highly significant correlation (P < 0,0001, p = 0.8) between the volume of the ventral lesion in the GPi and the improvement in LID in the contralateral limbs, whereas there was no correlation between the ventral volume and the improvement in parkinsonian 'off' signs. The volumes of the total Lesion cylinder and the dorsal lesion did not correlate with the outcome of either dyskinesias or parkinsonian 'off' signs. The differential predictive value of levodopa responsiveness for the outcome of parkinsonian 'off' signs and LID and the different correlations of ventral lesion volume with dyskinesias and parkinsonian 'off' signs indicate that different anatomical or pathophysiological substrates may be responsible for the generation of parkinsonian 'off' signs and dyskinesias, Whereas cells in a wider area of the GPi may be implicated in parkinsonism, the ventral GPi seems to be crucial for the manifestation of LID. We suggest that our observations are additional proof of the functional somatotopy of the systems within the GPi that mediate parkinsonism and dyskinesias, especially along the dorsoventral trajectory used in pallidotomy. The outcome of pallidotomy in which the lesion involves the ventral and dorsal GPI could be the net effect of alteration in the activity of pathways which mediate different symptoms, and hence could be variable.
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    Hyperglycemia control and outcome in acute ischemic stroke
    (INTERNATIONAL JOURNAL OF STROKE, 2014) Nair, S; Sylaja, PN; Sreedharan, SE; Sarma, S; Lipska, K
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    IMPACT OF GENDER ON OUTCOME OF EPILEPSY
    (EPILEPSIA, 2009) Gopinath, M; Sarma, S; Thomas, S
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    Moyamoya disease: A comparison of long term outcome of conservative and surgical treatment in India
    (JOURNAL OF THE NEUROLOGICAL SCIENCES, 2014) Sundaram, S; Sylaja, PN; Menon, G; Sudhir, J; Jayadevan, ER; Sukumaran, S; Sreedharan, SE; Sarma, S
    Background: Revascularization surgery (RS) is the therapy of choice in moyamoya disease (MMD). Due to rarity of disease and ethical concerns, randomized controlled trials about the treatment options are lacking. Very little information is available on the long-term outcome of conservatively treated moyamoya patients. Aim: We compared the long-term outcome of moyamoya patients treated conservatively to those who underwent RS. Methods: Our study population included all patients with moyamoya disease/syndrome from 2002 to 2012. The demographic, clinical characteristic and imaging details were reviewed. The outcome was obtained prospectively. Results: Of the 36 patients, 26 (72.2%) had MMD and 10 (27.8%) had moyamoya syndrome. The median age at onset of symptoms was 17.5 years (range, 10 months-55 years). Fifteen patients belonged to pediatric group and 21 were adults. All the pediatric patients had ischemic events at onset and 10 (47.6%) of the adults presented with hemorrhage. Twenty (55.6%) patients received conservative treatment and 16 (44.4%) underwent revascularization procedures. The median duration of follow-up was 28 months (range, 3-90 months). Three (18%) of the surgically treated patients had recurrent ischemic events on follow-up, but none of the conservatively treated patients had events. An excellent outcome (Modified Rankin Scale of <= 2) was seen in 12 (75%) surgically treated and 16 (94%) conservatively treated patients (p = 0.17). Conclusion: Compared to East Asians, our patients had a lower stroke recurrence rate and good functional outcome even with conservative treatment. Future studies should focus on clinical and imaging predictors of progression to select moyamoya patients for RS. (C) 2013 Elsevier B.V. All rights reserved.
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    OUTCOME FOLLOWING RESECTIVE SURGERY AND ITS DETERMINANTS IN DRUG RESISTANT POSTERIOR CORTEX EPILEPSY (PCE)
    (EPILEPSIA, 2011) Wattamwar, PR; Shivakumar, R; Radhakrishnan, A; Sarma, S; Radhakrishnan, K
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    Protocol for development of a risk assessment tool for planning and management of religious mass-gathering events of India-a health system-strengthening initiative
    (Pilot and Feasibility Studies, 2019-06) Sharma, U; Desikachari, BR; Sarma, S
    Background Religious mass gatherings (MGs) have always been an integral part of our society. At the outset, mass-gathering events provide challenging settings to plan a suitable emergency public health response. Published studies basically talk about retrospective reviews, case studies of the public health preparedness, or health care provided at individual events. Developing an understanding of the variables associated with MGs is the first step for public health managers. Risk assessment (RA) is a crucial part of pre-event planning as it helps foresee potential risks. Based on RA, one can develop preventive measures and ensure that the infrastructure to control the potential problems is in place. This study is an attempt to systemize RA process during MG events in a country that is culturally rich but with poor resources to handle such events. A RA tool will be developed for planning and management of religious MG events of India. Methods/design Various strategies will be used to develop the risk assessment tool (RA tool). Extensive review of literature clubbed with key informant interviews will be done in order to identify the risk variables and decide the domains and items of the tool. Further, this tool will be developed as a mobile-based application. The feasibility of the mobile-based RA tool will be tested in real-time MG event in one part of the country. Concurrently in the same event, a community survey of residents and visitors will be done in order to assess public perceptions of public health and environmental risks associated with MG events. Discussion The findings of this study will provide insights into the public health and environmental concerns that need to be considered if preventive strategies and intervention programs are to be designed for MG events. A “RA Tool,” which can be used in the planning and management of MG events by the public health managers will strengthen the existing health systems preparedness plans for MGs.
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    Response from the author: Breach rhythm
    (AMERICAN JOURNAL OF ELECTRONEURODIAGNOSTIC TECHNOLOGY, 2000) Radhakrishnan, K; Chandy, D; Menon, G; Sarma, S
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    Risk Factors, Outcome and Predictors of Outcome in Young Patients with Ischemic Stroke
    (CEREBROVASCULAR DISEASES, 2015) Kuruvilla, A; Mandliya, A; Sarma, S
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    Risk of stroke and cardiac events in medically treated asymptomatic carotid stenosis
    (INTERNATIONAL JOURNAL OF STROKE, 2014) Divya, KP; Nayani, S; Sarma, S; Sylaja, PN
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    Risk of Stroke and Cardiac Events in Medically Treated Asymptomatic Carotid Stenosis
    (JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, 2015) Divya, KP; Sandeep, N; Sarma, S; Sylaja, PN
    Background: The risk of stroke in patients with 50% or more asymptomatic carotid stenosis (ACS) on intensive medical treatment is low. Hence, the optimal treatment of ACS remains controversial at this point of time. Aim: We assessed the risk of stroke/transient ischemic attack (TIA) and cardiac events in patients with 50% or more ACS on intensive medical treatment. Methods: All patients with TIA/minor stroke (National Institutes of Health Stroke Scale score <= 5) who had undergone vessel imaging as part of their evaluation and patients with coronary artery disease who had undergone vessel imaging before cardiac intervention were screened for the presence of asymptomatic carotid stenosis. The risk of TIA/stroke, cardiac events, and vascular deaths were evaluated. Results: Of 1,800 patients, 92 patients (.05%) had ACS having 50% to 99% stenosis; 63 had TIA/minor stroke, and 29 had coronary artery disease, of whom 7 patients had bilateral ACS, thus constituting 99 study units of ACS. The mean follow-up was 34.7 months (range 3-120 months). Two patients developed ischemic events on the side ipsilateral to the ACS and 9 patients developed cardiac events during the follow-up. The average annual event rate for cerebral ischemic events was .93% (95% confidence interval [CI], .11-3.37), 4.21% (95% CI, 1.92-7.98) for cardiac events, and 3.27% (95% CI, 1.31-6.74) for death. Conclusions: Although the risk of stroke in patients with ACS is low, acute coronary events and vascular deaths were significant. This highlights the importance of intensive risk factor modification to reduce adverse cardiovascular events in ACS rather than revascularization of the carotid stenosis. (C) 2015 by National Stroke Association
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    STUDY OF VASCULAR RISK FACTORS AS A PREDICTOR OF WHITE MATTER DISEASE IN PATIENTS WITH ACUTE ISCHEMIC STROKE
    (INTERNATIONAL JOURNAL OF STROKE, 2016) Hiremath, N; Mohimen, A; Kesavadas, C; Sylaja, PN; Sarma, S