Browsing by Author "Varma, RP"

Now showing 1 - 9 of 9
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    Can transcranial magnetic stimulation be used to evaluate patients with narcolepsy?
    (NEUROLOGICAL SCIENCES, 2013) Vijayakumari, AA; Khan, FR; Varma, RP; Radhakrishnan, A
    Narcolepsy is a rare, chronic sleep disorder characterized by excessive daytime sleepiness, cataplexy and other manifestations of dissociated rapid eye movement in sleep. We assessed the utility of transcranial magnetic stimulation (TMS) as an objective tool to elucidate the cortical excitability changes and also to analyze its role in assessing the treatment efficacy in narcolepsy. Eight patients with narcolepsy under our regular follow-up from 2000 to 2009 at our Sleep disorder clinic were chosen. All of them underwent polysomnography, multiple sleep latency tests and TMS. Resting motor threshold (RMT), cortical silent period (CSP) and central motor conduction time (CMCT) were assessed using TMS in both drug-na < ve and post-treatment states. Eight controls were also subjected to all the three investigations. Appropriate statistical methods were used. The mean RMT (%) pre-treatment was higher in narcolepsy patients than that in controls, and it normalized following treatment. CSP and CMCT were unaffected in narcolepsy patients as compared to controls. This study shows that the cortical excitability is significantly low in narcolepsy patients. This motor cortex hypoexcitability becomes normal with the institution of treatment, pari passu with the control of symptoms. In future, TMS may be considered as an effective tool for documenting the treatment efficacy in patients with narcolepsy.
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    Children (10-12 years age) of women with epilepsy have lower intelligence, attention and memory: Observations from a prospective cohort case control study
    (EPILEPSY RESEARCH, 2015) Gopinath, N; Muneer, AK; Unnikrishnan, S; Varma, RP; Thomas, SV
    Objective: To compare the cognitive outcome of children of women with epilepsy (CWE) with matched controls (CWO). Methods: CWE (10-12 years) under follow up in Kerala Registry of Epilepsy and Pregnancy (n= 190) were evaluated with WISC-IV, Trail Making Test (TMT), Rey Auditory Verbal Learning Test (RAVLT) and compared with age and sex matched children of women without epilepsy - CWO (n = 149) drawn from schools in the same region. The dosage was expressed as prescribed daily dose/daily-defined dose (PDD/DDD) ratio in order to make comparisons. Results: The Full Scale IQ of CWE (77.9 +/- 14.6) was 8.5 points lower than that of CWO (86.4 +/- 13.4), which was statistically significant (p=0.001). They performed lower on TMT Part A & B and RAVLT. The FSIQ mean +/- SD; PDD/DDD ratio and number of monotherapy exposure for different anti-epileptic drugs were phenobarbital: (74.5 +/- 14; 1.1 +/- 0.8; 22), valproate: (82.8 +/- 12.4; 0.3 +/- 0.1; 36), carbamazepine: (82.2 +/- 13.9; 0.6 +/- 0.3; 41), phenytoin: (82.6 +/- 13.5; 0.8 +/- 0.3; 11). The FSIQ for those exposed to phenobarbital was significantly (p =0.01) lower than others. The significant predictors of FSIQ differed at lower and higher ends of its spectrum. These predictors were low body mass index and low maternal education for FSIQ < 80 and low maternal education, low maternal IQ and high anti-epileptic drug dosage for FSIQ < 86. High anti-epileptic drug dosage, low maternal IQ and low paternal education were the predictors for FSIQ < 92. Significance: The IQ attention and memory were significantly lower for 10-12 year old CWE when compared to CWO. The important predictors of low FSIQ were antiepileptic drug dosage, maternal IQ and parental education. (C) 2015 Elsevier B.V. All rights reserved.
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    Cluster randomised feasibility trial to improve the Control of Hypertension In Rural India (CHIRI): a study protocol
    (BMJ OPEN, 2016) Riddell, MA; Joshi, R; Oldenburg, B; Chow, C; Thankappan, KR; Mahal, A; Thomas, N; Srikanth, VK; Evans, RG; Kalyanram, K; Kartik, K; Maulik, PK; Arabshahi, S; Varma, RP; Guggilla, RK; Suresh, O; Mini, GK; D'Esposito, F; Sathish, T; Alim, M; Thrift, AG
    Introduction: Hypertension is emerging in rural populations of India. Barriers to diagnosis and treatment of hypertension may differ regionally according to economic development. Our main objectives are to estimate the prevalence, awareness, treatment and control of hypertension in 3 diverse regions of rural India; identify barriers to diagnosis and treatment in each setting and evaluate the feasibility of a community-based intervention to improve control of hypertension. Methods and analysis: This study includes 4 main activities: (1) assessment of risk factors, quality of life, socioeconomic position and barriers to changes in lifestyle behaviours in similar to 14 500 participants; (2) focus group discussions with individuals with hypertension and indepth interviews with healthcare providers, to identify barriers to control of hypertension; (3) use of a medicines-availability survey to determine the availability, affordability and accessibility of medicines and (4) trial of an intervention provided by Accredited Social Health Activists (ASHAs), comprising groupbased education and support for individuals with hypertension to self-manage blood pressure. Wards/ villages/hamlets of a larger Mandal are identified as the primary sampling unit (PSU). PSUs are then randomly selected for inclusion in the cross-sectional survey, with further randomisation to intervention or control. Changes in knowledge of hypertension and risk factors, and clinical and anthropometric measures, are assessed. Evaluation of the intervention by participants provides insight into perceptions of education and support of self-management delivered by the ASHAs. Ethics and dissemination: Approval for the overall study was obtained from the Health Ministry's Screening Committee, Ministry of Health and Family Welfare (India), institutional review boards at each site and Monash University. In addition to publication in peer-reviewed articles, results will be shared with federal, state and local government health officers, local healthcare providers and communities.
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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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    Exposure to firearm: impact on psychological health in central India
    (Indian Journal of Community Health, 2014-12) Saxena, S; Varma, RP; Soman, B
    Background: The issue of firearm exposure is one of the widespread prevailing problems in today’s world but at the same time it is least talked about. Its psychological effects vary from person to person and the degree of consequences has many variables to measure. The firearm exposure not only implies to an individual but also the whole gambit of social structures around him. Methods: A cross-section study on 505 subjects of the age group 20-45 years from central India was done, where routine social order depends upon massive armament of the citizen. We studied the relationship between socio-demographic variables and firearm exposure with variables of psychological domain of the WHOQOL-BREF. Multivariate logistic regression model was constructed to find the correlates among them. The objectives of the study were to study the attributes of socio demographic variables, which affects psychological health and exposure to firearms in the study population and to see the impact of exposure to firearms on psychological health. Results: Higher education is associated positively with psychological health. The desire to have a gun (OR=1.988, CI 1.306-3.024, p-value <.005) is showing a significant association with low psychological domain score of QOL. Being married (OR=.556, CI .344-.901, p-value <.005) and not Living in a joint family (OR=.581, CI .379-.891, p-value <.005) is associated with poor psychological health. Conclusions: Higher education is the best predictor for good psychological health. Semiskilled workers (farmers and laborers) should be prioritized as high risk groups for adverse life situations. Firearm exposures have a significant impact on psychological health. So, policies directed at rural population should target at specific needs of community.
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    Incidence of type-2 diabetes among industrial Workers in Kerala, India
    (International Journal of diabetes in developing countries, 2016-04) Thankappan, KR; Mini, GK; Sarma, PS; Varma, RP
    Kerala is the most advanced Indian state in epidemiological transition and has the highest type 2 diabetes prevalence. However, data on incidence of diabetes in Kerala are limited. We studied the incidence of diabetes and pre-diabetes among industrial workers. We measured fasting plasma glucose (FPG) among 326 workers (mean age 51 years, men 76 %) from two major industries in Kerala in the years 2009 and 2011 using standard protocol. Individuals with FPG ≥126 mg/dl or on medications for diabetes were considered to have diabetes mellitus, FPG ≥100 mg/dl and ≤125/dl mg as pre-diabetic, and FPG <100 mg/dl as normal. Among the 326 workers, 26.1 % (95 % CI 21.6–31.1) were diabetic, 32.8 % (CI 28.7–37.2) were pre-diabetic, and the remaining 41.1 % were having normal FPG at baseline. At year two, 13.3 % of the 241 workers who were either normal or had pre-diabetes at baseline developed diabetes providing an incidence rate of 6.65 % per year. Among the 134 workers with normal FPG at baseline 28.4 % progressed to pre-diabetes, 5.2 % developed diabetes, and among the 107 pre-diabetics, 23.4 % developed diabetes at year two. The odds of progressing to diabetes from pre-diabetes were five times higher compared to those from normal FPG (OR 5.53; CI 2.28–13.37). Progression to pre-diabetes and diabetes occurred at a very fast rate in this population indicating the need for preventive measures to slow down this fast progression
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    Multipoint incremental motor unit number estimation versus amyotrophic lateral sclerosis functional rating scale and the medical research council sum score as an outcome measure in amyotrophic lateral
    (Annals of Indian Academy of Neurology, 2014-12) Jagtap, SA; Kuruvilla, A; Govind, P; Nair, MD; Sarada, C; Varma, RP
    INTRODUCTION: Monitoring the disease progression in amyotrophic lateral sclerosis (ALS) is a challenge due to different rates of progression between patients. Besides clinical methods to monitor disease progression, such as the ALS functional rating scale (ALSFRS) and the medical research council (MRC) sum score, quantitative methods like motor unit number estimation (MUNE) are of interest. OBJECTIVE: The objective of the present study is to evaluate the rate of progression in ALS using multipoint incremental MUNE and to compare MUNE, ALSFRS and MRC sum score at baseline and at 6 months for progression of the disease. MATERIALS AND METHODS: Multipoint incremental MUNE using median nerve, ALS-FRS and MRC sum score was carried out in 29 ALS patients at baseline and then at 6 months. RESULTS: Of the 29 ALS patients studied, the mean MUNE at baseline was 21.80 (standard deviation [SD]: 19.46, range 4-73), 15.9 in the spinal onset group (SD: 14.60) and 30.16 (SD: 22.89) in the bulbar onset group. Spinal onset patients had 74.02% of baseline MUNE value while bulbar onset patients had only 24.74% baseline value MUNE at 6 months follow-up (Unpaired t-test, P = 0.001). ALSFRS and MRC sum score showed statistically significant decline (P < 0.001) at 6 months follow-up. MUNE had the highest sensitivity for progression of the disease when compared to the ALS FRS and MRC sum score. CONCLUSION: Multipoint incremental MUNE is a valuable tool for outcome measure in ALS and other diseases characterized by motor unit loss. The rate of decline of multipoint incremental MUNE is more sensitive than that of MRC sum score and ALSFRS-R, when expressed as the percentage change from baseline
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    Multipoint incremental motor unit number estimation versus amyotrophic lateral sclerosis functional rating scale and the medical research council sum score as an outcome measure in amyotrophic lateral sclerosis
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2014) Jagtap, SA; Kuruvilla, A; Govind, P; Nair, MD; Sarada, C; Varma, RP
    Introduction: Monitoring the disease progression in amyotrophic lateral sclerosis (ALS) is a challenge due to different rates of progression between patients. Besides clinical methods to monitor disease progression, such as the ALS functional rating scale (ALSFRS) and the medical research council (MRC) sum score, quantitative methods like motor unit number estimation (MUNE) are of interest. Objective: The objective of the present study is to evaluate the rate of progression in ALS using multipoint incremental MUNE and to compare MUNE, ALSFRS and MRC sum score at baseline and at 6 months for progression of the disease. Materials and Methods: Multipoint incremental MUNE using median nerve, ALS-FRS and MRC sum score was carried out in 29 ALS patients at baseline and then at 6 months. Results: Of the 29 ALS patients studied, the mean MUNE at baseline was 21.80 (standard deviation [SD]: 19.46, range 4-73), 15.9 in the spinal onset group (SD: 14.60) and 30.16 (SD: 22.89) in the bulbar onset group. Spinal onset patients had 74.02% of baseline MUNE value while bulbar onset patients had only 24.74% baseline value MUNE at 6 months follow-up (Unpaired t-test, P = 0.001). ALSFRS and MRC sum score showed statistically significant decline (P < 0.001) at 6 months follow-up. MUNE had the highest sensitivity for progression of the disease when compared to the ALS FRS and MRC sum score. Conclusion: Multipoint incremental MUNE is a valuable tool for outcome measure in ALS and other diseases characterized by motor unit loss. The rate of decline of multipoint incremental MUNE is more sensitive than that of MRC sum score and ALSFRS-R, when expressed as the percentage change from baseline.