Browsing by Author "Sarma, SP"

Now showing 1 - 14 of 14
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    Clinical and polysomnographic predictors of severe obstructive sleep apnea in the South Indian population
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2016) Sreedharan, SE; Agrawal, P; Rajith, RS; Nair, S; Sarma, SP; Radhakrishnan, A
    Background: With the emergence of lifestyle diseases in epidemic proportions, obstructive sleep apnea (OSA) is being increasingly recognized in less developed countries as well. Aim: We sought to study the demographic, clinical, and polysomnographic (PSG) predictors of OSA severity in a cohort of South Indian patients. Materials and Methods: Consecutive patients with PSG proven OSA [apnea hypopnea index (AHI) >= 5/h] were prospectively recruited. The study period was from January 2012 to December 2012. Demographic data, history of vascular risk factors, substance abuse, sleep quality, snoring, and witnessed apneas were collected using a structured pro forma. In addition, PSG variables such as AHI, sleep latency and efficiency, duration of slow wave and rapid eye movement (REM) sleep, and other parameters were collected. Correlations between AHI severity and clinical and PSG parameters were done. Results: There were 152 (119 males and 33 females) subjects with a mean age of 53.8 years and body mass index (BMI) of 29.31. Mean AHI was 36.2/h (range: 5.1-110) and 66 subjects had severe OSA. Around 12% had the presenting complaint as insomnia, mainly of sleep maintenance. Of the subjects, 35% had witnessed apneas and 67% had excessive daytime sleepiness (EDS); 40% of patients had >= 2 risk factors. PSG parameters showed short sleep onset latency with a high arousal index. Mean apnea duration was 24.92 s. We found that age >55 years, BMI > 25 kg/m(2), witnessed apneas, EDS, hypertension, dyslipidemia, reduced slow wave sleep duration, mean apnea duration > 20 s, and desaturation index > 10/h correlated well with OSA severity while the arousal index, sleep latency and efficiency, and exposure to smoking and alcohol showed no association. Conclusions: Older subjects with witnessed apneas are likely to have more severe OSA. Even though overall sleep architecture was similar between the groups, severe OSA had shorter slow wave sleep, longer apneas, and higher nocturnal hypoxemia.
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    Does F-18 FDG-PET substantially alter the surgical decision-making in drug-resistant partial epilepsy?
    (EPILEPSY & BEHAVIOR, 2015) Menon, RN; Radhakrishnan, A; Parameswaran, R; Thomas, B; Kesayadas, C; Abraham, M; Vilanilam, G; Sarma, SP
    Objective: There is a dearth of information on the critical utility of positron emission tomography (PET) in choosing candidates for epilepsy surgery especially in resource-poor countries where it is not freely available. This study aimed to critically analyze the utility of FDG-PET in the presurgical evaluation and surgical selection of patients with DRE based on the results obtained through its use in our comprehensive epilepsy program. Methods: From 2008 to 2012, 117 patients with drug-resistant epilepsy underwent F-18 fluoro-deoxy-glucose (FDG) PET in our center. We utilized their data to audit the utility of PET in choosing/deferring patients for surgery. Results: Of the 117 patients (age: 5-42 years) who underwent F-18 FDG-PET, 64 had normal MRI, and 53 had lesions. Electroclinical data favored temporal ictal onset in 48 (41%), extratemporal in 60 (51.3%), and uncertain lobar localization in 9 (7.7%). The topography of PET hypometabolism was localizing in 53 (45.3%), lateralizing in 12 (10.3%), and 52 (44.4%) had either normal or discordant results. In the nonlesional group, focal hypometabolism was concordant to the area of ictal onset in 27 (41.5%) versus 38 (58.5%) in the lesional group (p = 0.002). Greater concordance was noted in temporal lobe epilepsy (TLE) (78.0%) as compared to extratemporal epilepsy (ETPE) (28.6%) (p < 0.001). Positron emission tomography was more concordant in patients with mesial temporal sclerosis than in those with other lesions (82.8% versus 50%) (p = 0.033). Positron emission tomography helped in surgical decision-making in 68.8% of TLE and 23.3% of ETPE cases. Overall, 37 patients (31.6%) were directly selected for resective surgery based on PET results. Conclusions: Positron emission tomography, when utilized judiciously, remained an ancillary tool in the surgical selection of one-third of patients with drug-resistant partial epilepsy, although its utility as an independent tool is not very promising. (C) 2015 Elsevier Inc. All rights reserved.
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    Electro-clinical characteristics and postoperative outcome of medically refractory tumoral temporal lobe epilepsy
    (NEUROLOGY INDIA, 2005)
    Background: Very few studies have specifically addressed surgical treatment and outcome of patients with tumor-related temporal lobe epilepsy (TLE). Aim: To define the postoperative seizure outcome and the factors that influenced the outcome of patients with tumor-related TLE. Materials and Methods: We selected patients whose surgical pathology revealed a temporal lobe neoplasm and who had completed >= 1 year of postoperative follow-up. We reviewed the clinical, EEG, radiological and pathological data, and the seizure outcome of these patients and assessed the factors that influenced the outcome. Results: Out of the 409 patients who underwent surgery for refractory TLE during the 8-year study period, there were 34 (8.3%) patients with temporal lobe neoplasms. The median age at surgery was 20 years and the median duration of epilepsy prior to surgery was 9.0 years. MRI revealed tumor in the mesial location in 21 (61.8%) patients. Interictal and ictal epileptiform EEG abnormalities were localized to the side of th lesion in the majority. Mesial temporal lobe structures were included in the resection, if they were involved by the tumor; otherwise, lesionectomy alone was performed. During a median follow-up of 4 years, 27 (79%) patients were completely seizure-free. The only factor that predicted long-term seizure-free outcome was being seizure-free during the first two postoperative years. Conclusions: Our results emphasize the fact that in patients with tumoral TLE, when the seizures are medically refractory, surgery offers potential for cure of epilepsy in the majority.
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    Malformation in index pregnancy in women with epilepsy is not followed by recurrence in subsequent pregnancy
    (EPILEPSIA, 2013) Begum, S; Sarma, SP; Thomas, SV
    Use of antiepileptic drugs (AEDs) in pregnant women with epilepsy (WWE) is associated with an increased risk of major congenital malformations (MCM). Previous studies have suggested that WWE who had a malformation in their index pregnancy were at an increased risk of recurrence in future pregnancies. We aimed to assess the risk of recurrence of MCM in 1,616 WWE from Kerala Registry of Epilepsy and Pregnancy. The pregnancy outcome of women (n=246) with two prospective pregnancies in the registry were analyzed. They had partial seizures with or without generalization (57.3%) or generalized seizures (42.7%). Polytherapy was used in 26.4% (index pregnancy) and 23.6% (follow-up pregnancy). The mean dosage of AED for valproate was 498mg/day and carbamazepine was 555mg/day. The malformation rate in the index pregnancy was 8.5% (21/246) and in the follow-up pregnancy was 8.9% (22/246) with only one recurrence. There was no increased risk of MCM in follow-up pregnancy for those who had MCM in the index pregnancy (p=0.70; OR 0.49; 95% CI 0.06-3.80). The use of any specific drug, continuation of the same drug or a change in drug therapy between two pregnancies did not alter the recurrence risk.
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    Neoplastic meningitis: clinico-radiological features, outcome and prognostic factors
    (NEUROLOGY ASIA, 2010) Ramesha, KN; Kate, MP; Kesavadas, C; Radhakrishnan, VV; Sarma, SP; Thomas, SV
    Objective: This retrospective hospital based study aimed to describe clinico-radiological features and outcome of neoplastic meningitis (NM) and to evaluate the significance of the presence of malignant cells in CSF and identifiable primary in NM. Methods: The diagnosis of NM was based on the presence of malignant cells in CSF cytology, meningeal biopsy, post mortem examination or compatible clinico-radiological features in patients with known primary malignancy. For subgroup comparisons, Mann Whitney test and Fisher's exact test were used for continuous and categorical variables respectively. Relative risk of survival in positive CSF cytology for malignant cells and known primary versus negative were calculated. Results: There were 25 patients (mean age 44.5 +/- 17.6 years) of NM during the study period (2000-2008). They presented with raised ICP headache (72%), cauda equina syndrome (28%), or hemiparesis (12%). Meningeal enhancement and hydrocephalus were seen in 60% and 21% respectively. CSF analysis revealed hypoglychorrachia (64%), raised protein (68%) and pleocytosis (48%). CSF cytology for malignant cells was positive in 76% and cumulative positivity increased by 31% from 1(st) to 3(rd) lumbar punctures. A primary could be identified in 56% cases. At last follow up, 16 out of 18 had died. Hypoglychorrachia was the only variable analyzed, which predicted the cytology positivity (p=0.01). The mean duration of survival from the onset was significantly less in cytology positive group (p=0.001). The relative risk of survival at 90 days, 120 and 150 days were significantly higher in cytology and primary negative group compared to positive group. Conclusion: NM with positive cytology or with an identifiable primary tumor has a more aggressive course when compared to the negative groups and former have shorter lifespan. The possibility of positive cytology is high with hypoglychorrachia.
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    Prevalence and localizing value of emotional facial paresis in medically refractory temporal lobe epilepsy.
    (EPILEPSIA, 2005) Cherian, JP; Jacob, A; Radhakrishnan, K; Sarma, SP
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    RESECTIVE SURGERY FOR DRUG RESISTANT TUMORAL EPILEPSIES: SEIZURE OUTCOME AND ITS PREDICTORS
    (EPILEPSIA, 2013) Dash, GK; Radhakrishnan, A; Kesavadas, C; Abraham, M; Sarma, SP; Radhakrishnan, K
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    Screening Performance of Diabetes Risk Scores Among Asians and Whites in Rural Kerala, India
    (Prev Chronic Dis 2012, 2013-04) Sathish, T; Kannan, S; Sarma, SP; Thankappan, KR
    We compared the screening performance of risk scores for Asians and whites for diabetes, dysglycemia, and metabolic syndrome. Our subjects were 451 people aged 15 to 64 years who participated in a cohort study from May 2003 through September 2010 in a rural area of the Thiruvananthapuram district of Kerala, India. All outcome measures showed overlap in the range of area under the receiver operating characteristic curves of Asian and white diabetes risk scores (DRSs). Asian and white DRSs performed similarly in rural India
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    Seven-year longitudinal change in risk factors for non-communicable diseases in rural Kerala, India: The WHO STEPS approach.
    (Plos one, 2017-06) Sathish, T; Kannan, S; Sarma, SP; Razum, O; Sauzet, O; Thankappan, KR
    Nearly three-quarters of global deaths from non-communicable diseases (NCDs) occur in low- and middle-income countries such as India. However, there are few data available on longitudinal change in risk factors for NCDs in India. We conducted a cohort study among 495 individuals (aged 15 to 64 years at baseline) in rural Kerala state, India, from 2003 to 2010. For the present analysis, data from 410 adults (aged 20 to 64 years at baseline) who participated at both baseline and follow-up studies were analyzed. We used the World Health Organization STEPwise approach to risk factor surveillance for data collection. Age-adjusted change in risk factors for NCDs was assessed using the mixed-effects linear regression for continuous variables and the generalized estimating equation for categorical variables. The mean age of participants at baseline was 41.6 years, and 53.9% were women. The mean follow-up period was 7.1 years. There were significant increases in weight (mean change +5.0 kg, 95% confidence interval [CI] 4.2 to 5.8), body mass index (mean change +1.8 kg/m2 , 95% CI 1.5 to 2.1), waist circumference (mean change +3.9 cm, 95% CI 3.0 to 4.8), waist-toheight ratio (mean change +0.022, 95% CI 0.016 to 0.027), current smokeless tobacco use (men: odds ratio [OR] 1.6, 95% CI 1.1 to 2.2), alcohol use (men: OR 2.6, 95% CI 1.9 to 3.5; women: OR 4.8, 95% CI 1.8 to 12.6), physical inactivity (OR 2.0, 95% CI 1.3 to 3.0), obesity (OR 2.2, 95% CI 1.7 to 2.8), and central obesity (OR 1.9, 95% CI 1.5 to 2.3). Over a sevenyear period, several NCD risk factors have increased in the study cohort. This calls for implementation of lifestyle intervention programs in rural Kerala.
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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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    The decade after subthalamic stimulation in advanced Parkinson's disease: A balancing act
    (NEUROLOGY INDIA, 2016) Krishnan, S; Prasad, S; Pisharady, KK; Sarma, G; Sarma, SP; Kishore, A
    Aim: The duration of improvement in quality of life after subthalamic nucleus deep brain stimulation (STN DBS) for Parkinson's disease (PD) and the presurgical identification of factors predicting sustained clinical benefits have implications in patient selection and timing of surgery. These aspects were assessed in patients who underwent yearly assessment for at least 7 years after surgery. Materials and Methods: The quality of life, motor and cognitive outcomes of 25 patients who completed the 7-year assessment, and 12 patients who completed the 10-year assessment, were analyzed. Results: The improvement in quality of life was sustained only for 5 years, while the severity of motor signs and motor fluctuations remained reduced at 7 and 10 years. Tremor and rigidity showed more enduring reduction than bradykinesia and axial signs. The dose reduction in medications could be maintained until 7 years, by which time, the axial scores were worse than that seen at the pre-DBS levels. At 10 years, a higher levodopa requirement and recurrence of dyskinesias were noted. Patients with greater pre-DBS levodopa-responsive motor signs had greater long-term motor improvement. Conclusions: STN DBS performed in patients with advanced motor fluctuations and severe dyskinesias provide only an average of 5 years of quality of life improvement. STN DBS in patients with motor signs that are less responsive to levodopa results in shorter duration of clinical benefits. The improvements in the severity of motor fluctuations, rigidity, and tremor are the most enduring benefits of STN DBS that last a decade. However, these are offset by worsening axial and cognitive functions, bradykinesia, a higher levodopa requirement, and recurrence of dyskinesias by the end of the decade.
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    Usefulness of Wada test in predicting seizure outcome following anterior temporal lobectomy
    (EPILEPSY RESEARCH, 2013) Rathore, C; Kesavadas, C; Sarma, SP; Radhakrishnan, K
    Objective: To study the usefulness of the Wada test for predicting seizure outcome following anterior temporal lobectomy (ATL). Methods: From 1996 to 2002, all patients with left mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS) and selected patients with right MTLE-HS underwent the Wada test before ATL at our center. Patients were selected for ATL on the basis of unilateral HS on MRI and concordant electro-clinical data. Twelve-item recognition paradigm was used for Wada memory testing. Score of +1 was awarded for a correct response and -0.5 for an incorrect response. We defined Wada failure as a contralateral score of <5, ipsilateral score of >8, and difference score of <0. No patient was denied surgery based on the Wada results. Means of the three scores were compared between seizure free and non-seizure free patients. Sensitivity, specificity and receiver operator characteristic curves of various scores for predicting seizure outcome were calculated. Results: 151 patients (129 left MTLE; mean age: 27.80 +/- 8.72 years) formed the study group. At mean postoperative follow-up of 6.4 +/- 2.0 years, 127 patients were seizure free. Mean contralateral score was lower in the seizure-free group (7.15 +/- 3.07 vs. 8.71 +/- 4.13; p < 0.001) while ipsilateral and difference scores were similar between the two seizure outcome groups. Areas under the curves for contralateral, ipsilateral and difference scores for predicting seizure-free outcome were 0.49, 0.58 and 0.59, respectively, suggesting its modest usefulness in individual patients. Results remained same when the analysis was restricted to left MTLE patients. Conclusions: Wada test has limited usefulness for predicting seizure outcome following ATL. (C) 2013 Elsevier B.V. All rights reserved.
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    Utilization of Comprehensive Health Insurance Scheme, Kerala: A Comparative Study of Insured and Uninsured Below-Poverty-Line Households
    (ASIA-PACIFIC JOURNAL OF PUBLIC HEALTH, 2016) Philip, NE; Kannan, S; Sarma, SP
    We aimed to compare the sociodemographics, health care utilization pattern, and out-of-pocket (OOP) expenses of 149 insured and 147 uninsured below-poverty-line households insured under the Comprehensive Health Insurance Scheme, Kerala, through a comparative cross-sectional study. Family size more than 4 (odds ratio [OR] = 2.34; 95% confidence interval [CI] = 1.13-4.82), family member with chronic disease (OR = 2.05; 95% CI = 1.18-3.57), high socioeconomic status (OR = 2.95; 95% CI = 1.74-5.03), and an employed household head (OR = 2.69; 95% CI = 1.44-5.02) were significantly associated with insured households. Insured households had higher inpatient service utilization (OR = 1.57; 95% CI = 1.05-2.34). Only 40% of inpatient service utilization among the insured was covered by insurance. The mean OOP expenses for inpatient services among insured (INR 448.95) was higher than among uninsured households (INR 159.93); P = .003. These findings show that urgent attention of the government is required to redesign and closely monitor the scheme.
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    Validity of Montreal Cognitive Assessment in Non-English speaking patients with Parkinson's disease
    (NEUROLOGY INDIA, 2015) Krishnan, S; Justus, S; Meluveettil, R; Menon, RN; Sarma, SP; Kishore, A
    Background: The Montreal Cognitive Assessment is a brief and easy screening tool for accurately testing cognitive dysfunction in Parkinson's disease. We tested its validity for use in non-English (Malayalam) speaking patients with Parkinson's disease. Materials and Methods: We developed a Malayalam (a south-Indian language) version of Montreal Cognitive Assessment and applied to 70 patients with Parkinson's disease and 60 age-and education-matched healthy controls. Metric properties were assessed, and the scores were compared with the performance in validated Malayalam versions of Mini Mental Status Examination and Addenbrooke's Cognitive Examination. Results: The Montreal Cognitive Assessment-Malayalam showed good internal consistency and test-retest reliability and its scores correlated with Mini Mental Status Examination (patients: R = 0.70; P < 0.001; healthy controls: R = 0.26; P = 0.04) and Addenbrooke's Cognitive Examination (patients: R = 0.8; P < 0.001; healthy controls: R = 0.52; P < 0.001) scores. Conclusion: This study establishes the reliability of cross-cultural adaptation of Montreal Cognitive Assessment for assessing cognition in Malayalam-speaking Parkinson's disease patients for early screening and potential future interventions for cognitive dysfunction.