Browsing by Author "Thomas, Sanjeev V."
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Item Addressing problems of dementia in India(ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2011)Item Another milestone for the Annals of Indian Academy of Neurology(ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2009)Item Antimicrobial resistance: Neurologists role in containment and prevention(ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2011)Item Brain death and the apnea test(ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2009)Item Child rearing knowledge and practice scales for women with epilepsy(ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2010)Background: Comprehensive instruments to evaluate the child rearing knowledge and practice are not readily available for clinical research. Materials and Methods: We have designed in two phases a new instrument to evaluate the child rearing knowledge and practice under the four major domains of child rearing. Twenty-five subject experts from the field of Paediatrics, Obstetrics, Neurology and Nursing elicited the content validity of the instrument. The test retest reliability was evaluated by 25 young mothers who completed the CRKS at an interval of two weeks. Results: The Content Validity Ratio (CVR) of individual items ranged between 0.6 to 1. The reliability was tested for the 20 individual items of the CRKS using Kappa coefficient. The measurement of agreement Kappa ranged from 0.51 to 1. The total knowledge scores and sub scores data were analysed for correlation using Pearson's correlation coefficient. A significant Pearson's correlation indicated that the total scores were consistent over time (r = 0.89). The sub scores on feeding (6 items), Growth and development (4 items), protection (7 items), and infant stimulation (3 items) were found to have reliability of 0.91, 0.76, 0.84, and 0.89 respectively using Pearson's correlation. Conclusion: The instrument is found to be valid and reliable and can be used to measure child rearing knowledge and practice in early infancy.Item Climate, health and disease(ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2008)Item Confronting the stigma of epilepsy(ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2011)Stigma and resultant psychosocial issues are major hurdles that people with epilepsy confront in their daily life. People with epilepsy, particularly women, living in economically weak countries are often ill equipped to handle the stigma that they experience at multiple levels. This paper offers a systematic review of the research on stigma from sociology and social psychology and details how stigma linked to epilepsy or similar conditions can result in stereotyping, prejudice and discrimination. We also briefly discuss the strategies that are most commonly utilized to mitigate stigma. Neurologists and other health care providers, social workers, support groups and policy makers working with epilepsy need to have a deep understanding of the social and cultural perceptions of epilepsy and the related stigma. It is necessary that societies establish unique determinants of stigma and set up appropriate strategies to mitigate stigma and facilitate the complete inclusion of people with epilepsy as well as mitigating any existing discrimination.Item Economic recession and health of the people(ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2009)Item Fewer women receive tertiary care for epilepsy in Kerala State, India(EPILEPTIC DISORDERS, 2006)Purpose. The stigma attached to epilepsy often restricts early diagnosis and optimal care, particularly among the underprivileged. We aimed to ascertain any gender bias in the utilization of services for epilepsy in a tertiary and community care facility in Kerala State, India. Methods. The R. Madhavan Nayar Center for Comprehensive Epilepsy Care (RMNC) is a leading tertiary care facility in South India. The District Mental Health Program (DMHP) is a community-based care facility that provides medical consultation and antiepileptic drugs (AED) free of charge. We analyzed the sex ratio (SR) - number of women per one thousand men - of all registrations in these centers according to year of registration, age, religion, income, distance from domicile to the center, and religion. Results. The SR in the RMNC (1976-2004, n = 12354) was 729. At RMNC, age-specific SR increased up to the 3(rd) decade (864), and progressively declined beyond 50 years. The SR was lower for those domiciliated at more than 200 km from the center when compared to others. The SR at the DMHP (1999-2004, n = 221) was high (1125). The age-specific SR at DMHP showed two peaks at 21-30 years (1368) and 51-60 years (2333). Conclusion. Fewer women with epilepsy (particularly in lower socioeconomic groups) receive tertiary care in this state, in spite of a higher SR in the community (907 for epilepsy and 1058 for all population). The tertiary treatment gap is wider for women over 30 years (particularly over 50 years), when their longer life expectancy is also taken into consideration.Item Focal neuronal loss, reversible subcortical focal T2 hypointensity in seizures with a nonketotic hyperglycemic hyperosmolar state(NEURORADIOLOGY, 2007)Introduction Neuroimaging in seizures associated with nonketotic hyperglycemia (NKH) is considered normal. We report magnetic resonance imaging (MRI) abnormalities in four patients with NKH and seizures.Methods We prospectively evaluated clinical and radiological abnormalities in four patients with NKH during the period March 2004 to December 2005.Results All patients presented with seizures, either simple or complex partial seizures or epilepsia partialis continua. Two of them had transient hemianopia. MRI showed subcortical T2 hypointensity in the occipital white matter and in or around the central sulcus (two patients each), T2 hyperintensity of the overlying cortex (two patients), focal overlying cortical enhancement (three patients) and bilateral striatal hyperintensity (one patient). Diffusion-weighted imaging (DWI) performed in three patients showed restricted diffusion. The ictal semiology and electroencephalographic (EEG) findings correlated with the MRI abnormalities. On clinical recovery, the subcortical T2 hypointensity and striatal hyperintensity reversed in all patients. The initial cortical change evolved to FLAIR hyperintensity suggestive of focal cortical gliosis. The radiological differential diagnosis considered initially included encephalitis, malignancy and hemorrhagic infarct rendering a diagnostic dilemma.Conclusion We identified subcortical T2 hypointensity rather than hyperintensity as a characteristic feature of seizures associated with NKH. Only very few similar reports exist in literature. Reversible bilateral striatal T2 hyperintensity in NKH has not been reported to the best of our knowledge.Item From Thomas Willis to New Delhi(ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2008)Item Fungal infections of the central nervous system in HIV-negative patients: Experience from a tertiary referral center of South India(ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2010)Objective: To describe the clinical, radiological, and cerebrovascular fluid (CSF) findings and the outcome of microbiologically or histopathologically proven fungal infections of the central nervous system (CNS) in HIV-negative patients. Methodology and Results: We identified definite cases of CNS mycosis by screening the medical records of our institute for the period 2000-2008. The clinical and imaging details and the outcome were abstracted from the medical records and entered in a structured proforma. There were 12 patients with CNS mycosis (i.e., 2.7% of all CNS infections treated in this hospital); six (50%) had cryptococcal infection, three (25%) had mucormycosis, and two had unclassified fungal infection. Four (33%) of them had diabetes as a predisposing factor. The common presentations were meningoencephalitis (58%) and polycranial neuritis (41%). Magnetic resonance imaging revealed hydrocephalus in 41% and meningeal enhancement in 25%, as well as some unusual findings such as subdural hematoma in the bulbocervical region, carpeting lesion of the base of the skull, and enhancing lesion in the cerebellopontine angle. The CSF showed pleocytosis (66%), hypoglycorrhachia (83%), and elevated protein levels (100%). The diagnosis was confirmed by meningocortical biopsy (in three cases), paranasal sinus biopsy (in four cases), CSF culture (in three cases), India ink preparation (in four cases), or by cryptococcal polysaccharide antigen test (in three cases). Out of the ten patients for whom follow-up details were available, six patients recovered with antifungal medications (amphotericin B, 1 mg/kg/day for the minimum period of 6 weeks) and/or surgical treatment. Four patients expired (only one of them had received antifungal therapy). Conclusions: Most patients with CNS mycosis recover with appropriate therapy, but the diagnosis and management of these rare infections remains a challenge to clinicians.Item Intellectual and language functions in children of mothers with epilepsy(EPILEPSIA, 2007)Purpose: To compare the intellectual and language functions of children of mothers with epilepsy (CME) with that of controls matched for age and socioeconomic status.Methods: Cases were CME, aged six years or more (n = 71), drawn from a prospective cohort in the Kerala Registry of Epilepsy and Pregnancy. Controls were 201 children of parents without epilepsy, matched for age and socioeconomic status. The outcome measures included Indian adaptation of Wechsler Intelligence Scale for children and MLT a locally developed proficiency test for regional language. All relevant data were abstracted from the registry records.Results: The Full Scale IQ and MLT scores were significantly lower for the cases ( 87.7 +/- 22.6 and 73.4 +/- 17.3) compared to controls (93.0 +/- 14.4 and 83.2 +/- 11.8). Compared to controls, CME scored poor on all subtests of MLT but their impairment was confined to only some of the subtests of IQ. Maternal education and maternal IQ significantly correlated with low IQ and MLT scores for CME whereas type of epilepsy, seizures during pregnancy or low birth weight did not have any significant association with these outcome measures. Polytherapy and higher dosage of antiepileptic drugs (AEDs) were associated with significant impairment in outcome measures. Infants with low developmental quotient at one year of age continued to have low scores on outcome measures at six years.Conclusions: Low maternal IQ, maternal education, and antenatal AED exposure were associated with significant impairment of intellectual and language functions for CME at six years.Item Intracranial infectious aneurysm: Presentation, management and outcome(JOURNAL OF THE NEUROLOGICAL SCIENCES, 2007)Background: Intracranial infectious aneurysms (IA) are infrequent, but can be fatal.Objectives: To compare the clinical profile of IAs associated with intravascular/systemic infection like infective endocarditis with that associated with local infections like meningitis, orbital cellulitis and cavernous sinus thrombosis.Methods: We analysed all cases of IA, treated in this Institute from 1976 to 2003, in order to identify prognostic factors.Results: There were 25 persons (mean age 24.8 +/- 17.3 years, males 17) with 29 IA (carotid circulation 19, vertebrobasilar circulation 10). Headache (83%) and fever (67%) were the most common presenting symptoms. In contrast to noninfectious aneurysms, intracerebral haemorrhage (60%) and focal signs were more common than subarachnoid haemorrhage (7%) with [A. Sources of infection were cardiac (10), meningitis (12), orbital cellulitis (2) or uncertain (I). Infective agents included bacteria (18), fungi (4), and tubercle bacilli (3). Fifteen]A were distal and 14 were proximal. IAs associated with meningitis were proximal (75%) while those associated with cardiac diseases preferentially involved carotid territory and were distal (p=0.013). The overall mortality was 32%. Survivors were younger than those who expired (p=0.015). Of the sixteen patients treated medically, seven recovered (44%), others (56%)) had treatment failure (three died and six required surgery later). Another five patients underwent early Surgery (one died). Mortality of IA was significantly higher with meningitis, fungal aetiology and vertebrobasilar location.Conclusions: IAs associated with local infections like meningitis had different clinical profile as compared to IAs associated with intravascular/systemic infections like infective endocarditis. (C) 2007 Elsevier B.V. All rights reserved.Item Intracranial Microbial Aneurysm (Infectious Aneurysm): Current Options for Diagnosis and Management(NEUROCRITICAL CARE, 2009)The histopathological characteristic of intracranial microbial aneurysm (MA)-infectious aneurysm is the presence of infection and destruction of the walls of the vessels. It can occur in the setting of predisposing infections that spread by endovascular mechanism (e.g., infective endocarditis) or extravascular mechanism (e.g., meningitis). MA is probably a better term than mycotic, infectious, or infective aneurysm as a wide variety of bacteria, fungi, mycobacteria, and virus can cause MA. Typically MAs are multiple, distal, and fusiform aneurysms, but the angiographic and clinical presentations can vary widely. The most common presentation of MA is intracranial bleed. CT angiography, MR angiography, or Digital subtraction angiography can be deployed to detect MA. By combining the clinical findings, imaging, and angiographic findings, it is possible to arrive at a correct diagnosis in most instances. MAs carry higher risk of rupture and fatal bleed when compared to other aneurysms. The treatment options include antimicrobial therapy, surgery, and endovascular therapy. The management strategy is based on large case series rather than controlled trials. All MA should receive appropriate antibiotic therapy. Ruptured MA with mass effect would require surgery in most situations, while those without mass effect and in non-eloquent locations could also be managed by endovascular therapy. Unruptured MA could be managed according to the size, location, and risk of bleeding-by antibiotic therapy, surgery, or endovascular therapy. Monitoring the resolution of the MA under antibiotic therapy by serial CT angiography is another option, but it carries higher risk of bleeding. Treatment of the underlying predisposing infection is an important component of therapy.Item Investing in women, girls, and other matters(ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2009)Item Lipid peroxidation in women with epilepsy(ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2008)Background: Lipid peroxidation is an indicator of free radical metabolism and oxidative stress in human beings and other organisms. Malondialdehyde (MDA), an end product of lipid peroxidation, is a metabolite that can be readily estimated in serum samples. Excess oxidative stress may be a final common pathway through which anti epileptic drugs may exert their teratogenic potential in pregnant women with epilepsy. Our objective in this study was to ascertain the variations in malondialdehyde (MDA) in women with epilepsy. Material and Methods: This study was carried out in the Kerala Registry of Epilepsy and pregnancy after obtaining clearance from the Institutional Ethics Committee. Informed consent was obtained from all the subjects. The quantitative examination of MDA was performed according to standard procedures. The ideal plasma level of MDA is below 2 nmol/ml. Results: Fifteen women with confirmed epilepsy (mean age 26.9 +/- 3.5) were included in the study. Two women were pregnant. MDA levels ranged from 1.7 to 2.8 nmol/ml (mean level = 2.13 +/- 0.37 nmol/ml). Eight women (53 ) had MDA levels above the upper limit of normal. Three patients had levels above 2.5 nmol/ml, which corresponded to the 75 centile. Conclusions: This study had shown that the estimation of MDA levels in plasma is a convenient method to study lipid peroxidation and thereby oxidative stress in women with epilepsy. Over half of Women With Epilepsy (WWE) have excess oxidative stress as indicated by high levels of MDA in the plasma. Correlations between MDA level and characteristics of epilepsy, AED therapy, nutritional status and other medical conditions need to be observed in a larger cohort.Item Little strokes, big trouble and more.(ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2008)Item Managing epilepsy in pregnancy(NEUROLOGY INDIA, 2011)There are close to one and half million women with epilepsy (WWE) in reproductive age group in India. WWE have several unique gender-specific problems in the biological and social domains. Women experience more social stigma from epilepsy and have more difficulty with education and employment. They have more difficulty to get married and sustain successful family life. Reproductive hormones like estrogen and progesterone have opposing effect on seizure threshold. WWE have increased risk of infertility. About 10% of their babies may have major congenital malformations. Most of the adverse biological outcomes for WWE are related to adverse effects of antiepileptic drugs (AEDs). Traditional AEDs like phenobarbitone and sodium valproate are probably associated with increased risk of fetal malformations or other adverse fetal outcomes. Polytherapy and use of high dose of any AED is associated with higher risk fetal complications. It is very important that all WWE have a preconception evaluation done by a neurologist, when the need to continue AEDs or possibility of reducing AED load could be assessed. All WWE need to take folic acid 5 mg daily during preconception period and pregnancy. They should undergo a detailed screening for fetal malformations between 12 and 18 weeks of pregnancy. The neurologist, gynecologist, imageologist and pediatrician need to work as a team while managing pregnancy in WWE. It is important to reassure WWE and their relatives that pregnancy is safe in WWE and their children are healthy in more than 90% instances.Item Minimising disability in stroke survivors Reply(ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2009)