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Papers by Birinder Paul

Research paper thumbnail of Multiple Sclerosis Relapse Presenting as Sensorineural Hearing Loss

Research paper thumbnail of Decompressive craniectomy in malignant middle cerebral artery infarct: An institutional experience

Asian journal of neurosurgery, Sep 1, 2015

The purpose of this article was to share author's experience with decompressive craniectomy in ma... more The purpose of this article was to share author's experience with decompressive craniectomy in malignant middle cerebral artery (MCA) infarct with special emphasis on patients older than 60 years and those operated outside 48 h after onset of stroke. The surgical procedure involves temporarily removal of a large segment of the cranium (fragments of frontal, temporal, and parietal bones) followed by opening of dura in order to provide extra space into which the injured or ischemic brain can expand. Decompressive craniectomy has largely replaced the removal of brain tissue (i.e. lobectomy) as the preferred surgical option. [1] The concept of decompression first introduced by Annandale in late 1890. Later, Kocher in 1901 and Harvey Cushing in 1905 proposed decompressive craniectomy for relieving raised intracranial pressure. Unfortunately, technique got limited due to poor esthetical results. [2] The landmark work of Guerra et al. (decompressive craniectomy for traumatic brain swelling) established the procedure as an appropriate therapy for refractory intracranial pressure (ICP) of any origin in 1999. [3] We present out the experience of decompressive craniectomy in last 2½ years in malignant MCA infarct.

Research paper thumbnail of Clinical predictors of mechanical ventilation in Guillain-Barré syndrome

Neurology India, 2012

Patients with Guillain-Barré syndrome (GBS) require assisted ventilation frequently. However, no ... more Patients with Guillain-Barré syndrome (GBS) require assisted ventilation frequently. However, no single factor can predict ventilator requirement. To identify clinical variables which could predict the need for mechanical ventilation in GBS. Tertiary hospital-based retrospective and prospective study. One hundred and thirty-eight GBS patients studied were divided into two groups ventilated (Group 1) and non-ventilated (Group 2). Parameters assessed included age, gender, associated illness(es), antecedent events, first symptom at onset, time from onset to bulbar involvement, confinement to bed and peak disability, upper limb power and reflexes at nadir, presence of facial weakness, neck muscle weakness and autonomic dysfunction. Multivariate predictors of ventilation were assessed using logistic regression analysis. There were 53 patients in Group 1 and 85 in Group 2. The mean age in the two groups was comparable. On bivariate analysis, simultaneous weakness of upper (UL) and lower (LL) limbs as the initial symptom (P<0.001); UL power less than Grade 3/5 at nadir (P<0.001); presence of neck and bulbar weakness (P<0.001); shorter duration from onset to bulbar weakness and confinement to bed (P=0.001) and bilateral facial involvement (P<0.01) were more frequently associated with the need for ventilation. Preserved reflexes in UL at nadir was significantly associated with absence of the need for mechanical ventilation (P<0.01). On multivariate analysis, factors independently associated with the need for mechanical ventilation included simultaneous motor weakness in UL and LL as the initial symptom (P=0.02), UL power<3/5 (Medical Research Council grade) at nadir (P=0.013) and presence of bulbar weakness…

Research paper thumbnail of Author Response: Multiple Sclerosis Relapse Presenting as Sensorineural Hearing Loss

Research paper thumbnail of An Emergency Message and Call System for People with Epilepsy

2022 IEEE International Instrumentation and Measurement Technology Conference (I2MTC), May 16, 2022

Research paper thumbnail of Multi-parameter Wearable Band for Wireless Data Collection from People with Epilepsy

2022 IEEE International Instrumentation and Measurement Technology Conference (I2MTC), May 16, 2022

Research paper thumbnail of An Uncommon Case of Celiac Disease and Deep Cerebral Venous Sinus Thrombosis

Journal of Neurosciences in Rural Practice

Celiac disease is an enteropathy characterized by malabsorption related with gluten intolerance a... more Celiac disease is an enteropathy characterized by malabsorption related with gluten intolerance and immune-mediated pathogenesis. It may manifest with gastrointestinal features like diarrhea, abdominal pain, weight loss, and anemia. Besides, it can manifest with various extraintestinal features like ataxia, neuropathy, stroke, or sometimes venous sinus thrombosis. Being of autoimmune origin, relation with systemic lupus erythematosus has also been reported. Herein, we present a rare case of a young patient with celiac disease who presented with fever, headache, and altered sensorium and was found to have meningitis with deep cerebral venous sinus thrombosis.

Research paper thumbnail of Abstract 14683: Efficacy of Sovateltide (PMZ-1620), a First-in-Class Neuronal Progenitor Cell Therapeutics, in Patients With Cerebral Ischemic Stroke

Circulation, Nov 19, 2019

Research paper thumbnail of Etiology and Pathogenesis of Parkinson's Disease

Annual Review of Neuroscience, 1999

▪ Parkinson's disease (PD) is an age-related neurodegenerative disorder that affects approx... more ▪ Parkinson's disease (PD) is an age-related neurodegenerative disorder that affects approximately 1 million persons in the United States. It is characterized by resting tremor, rigidity, bradykinesia or slowness, gait disturbance, and postural instability. Pathological features include degeneration of dopaminergic neurons in the substantia nigra pars compacta coupled with intracytoplasmic inclusions known as Lewy bodies. Neurodegeneration and Lewy bodies can also be found in the locus ceruleus, nucleus basalis, hypothalamus, cerebral cortex, cranial nerve motor nuclei, and central and peripheral components of the autonomic nervous system. Current treatment consists of a dopamine replacement strategy using primarily the dopamine precursor levodopa. While levodopa provides benefit to virtually all PD patients, after 5–10 years of treatment the majority of patients develop adverse events in the form of dyskinesia (involuntary movements) and fluctuations in motor response. Furthe...

Research paper thumbnail of To study the medication adherence patterns in Parkinson's disease and it's impact on quality of life

Parkinsonism & Related Disorders, Oct 1, 2020

Research paper thumbnail of Gender Differences in Impulse Control Disorders and Related Behaviors in Patients with Parkinson's Disease and its Impact on Quality of Life

Annals of Indian Academy of Neurology

Background: Dopaminergic medications administered to remedy motor symptoms in Parkinson’s disease... more Background: Dopaminergic medications administered to remedy motor symptoms in Parkinson’s disease are associated with an enhanced risk for impulse control disorders (ICD) and related compulsive behaviors (ICD-RB). Thus, the present study focuses on investigating the gender difference in the prevalence of ICD-RBs in Indian PD patients on dopamine replacement therapy (DRT), its impact on quality of life and to identify ICDs relevant in Indian scenario apart from the criteria set in QUIP-RS. Method: This was a hospital-based observational cross-sectional study in which Parkinson’s disease patients attending neurology clinic were included. Complete details of anti-parkinsonian therapy along with demographic and clinical variables were recorded on a predesigned Performa. Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s disease (QUIP), which is a validated quick screening tool, was used to detect ICD-RBs. The relative frequency and comparative impact of ICD on health-related quality of life (QOL) was studied using validated PDQ-39 Questionnaire. Results: Out of 102 patients, at least one ICD or ICD-RB was present in 41.19% and ≥2 ICD-RBs were present in 15.59%. At least one ICD was present in 16.67%, any ICD-related compulsive behaviors was present in 34.31% patients. The most common was punding and compulsive medication use (12.75% each), followed by hobbyism (7.84%), compulsive eating (6.86%), pathological gambling (3.92%), and hypersexuality, walkabout, and compulsive shopping (2.94% each). ICDs not classified elsewhere such as trichotillomania were found 3 patients (2.94%). ICD-RBs showed a trend to be more frequent in women (44.82% women vs. 39.39% men). As compared with patients without ICD-RBs, those with ICD-RBs were found to have higher dose of LD and DA and higher Hoehn and Yahr stage. ICD-RBs have a negative impact on the quality of life of Parkinson’s disease patients. Conclusion: ICDs and ICD-RBs have been included in the behavioral spectrum of nonmotor symptoms in PD. PD patients are at increased risk of developing ICD-RBs which interfere with important activities and have obligation in ordinary life, leading to legal and psychological consequences with a great impact on QOL.

Research paper thumbnail of Clinical Challenge: Dural Arteriovenous Fistula Presenting as Venous Encephalopathy

Neurology India, Jul 23, 2022

Research paper thumbnail of A cluster‐randomized trial comparing home‐based primary health care and usual clinic care for epilepsy in a resource‐limited country

Epilepsia Open

This is an open access article under the terms of the Creative Commons Attribution License, which... more This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Research paper thumbnail of SARS-CoV-19-associated Rhino-orbital and cerebral mucormycosis: clinical and radiological presentations

Medical Mycology

We describe presenting clinical and imaging manifestations of severe acute respiratory syndrome c... more We describe presenting clinical and imaging manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated Rhino-oculo-cerebral mucormycosis (ROCM) in a hospital setting during the second wave of SARS-CoV-2 pandemic in India. Data on the presenting manifestations were collected from 1 March to 31 May 2021. Associations between clinical and imaging findings were explored, specifically: (1) the presence or absence of orbital pain and infiltration of a superior orbital fissure on imaging; (2) the presence of unilateral facial nerve palsy and pterygopalatine fossa infiltration and geniculate ganglion signal on contrast magnetic resonance imaging, and (3) vision loss and optic nerve findings on imaging. Orbital pain was reported by 6/36 subjects. A fixed, frozen eye with proptosis and congestion was documented in 26 (72%), complete vision loss in 23 (64%), and a unilateral lower motor neuron facial nerve palsy in 18 (50%). No association was found between the p...

Research paper thumbnail of Analysis of trimodal pattern of mortality among hospitalized COVID-19 patients- Lessons from tertiary care hospital

Journal of Anaesthesiology Clinical Pharmacology

Research paper thumbnail of Neuropathy in Parkinson's disease: Risk determinants and impact on quality of life

Annals of Indian Academy of Neurology

Research paper thumbnail of Factors affecting adherence to pharmacotherapy in parkinson's disease

Annals of Indian Academy of Neurology, 2021

Background: The goal of dopaminergic replacement therapy to achieve good clinical outcome in Park... more Background: The goal of dopaminergic replacement therapy to achieve good clinical outcome in Parkinson's disease (PD) patients largely depends on the pattern of adherence to the pharmacological treatment. This study aims to find the factors affecting medication adherence in patients with PD keeping in mind the cultural, economic, and social diversities so that preventive steps can be taken to fill these gaps.Methods: Demographic data, disease parameters, treatment-related factors, family characteristics, educational, and employment status were assessed for relationship with the medication adherence pattern in a cohort of non-demented PD patients. Medication adherence was measured by MMAS-8; depression, and socioeconomic status were assessed by GDS-SF and Kuppuswamy scales respectively. Results: From 134 PD subjects, high adherence was observed in 43.2%, 18.2% had moderate, and 38.6% reported low adherence level to their pharmacotherapy. The sub-optimal level of adherence was significantly correlated to compliance of follow up with the physician (p 0.03), presence of adverse events related to drugs (p 0.03), and depressive symptoms (p < 0.0001). Also, there was significant negative co-relationship between poor adherence and depression on Spearman's rank coefficient (0.702). There was no effect of demographic factors, living conditions, family type, educational qualification, associated comorbid conditions, and socioeconomic status on adherence to dopaminergic treatment in patients with PD. Conclusion: Poor adherence to prescribed medication is a menace that is more than just oversimplification of forgetfulness which should be evaluated at each visit to improve efficacy of the prescribed regimen to achieve better treatment result and thus quality of life of PD patients.

Research paper thumbnail of Aggressive Vertebral Hemangioma: The Mystery of Spastic Legs Unveiled by a Purple Shoulder

Cureus, 2022

Vertebral hemangiomas (VHs) are benign vascular tumors that develop from the endoderm of blood ve... more Vertebral hemangiomas (VHs) are benign vascular tumors that develop from the endoderm of blood vessels, although their exact pathogenesis is poorly understood. Most hemangiomas are small, about a third are multiple in number, and a very small number of these hemangiomas cause symptoms. Even more rare are aggressive VHs, which comprise a small number of all VHs, and are associated with expansion and extraosseous extension into the paraspinal and epidural spaces. Management of aggressive VHs involve preop embolization, spinal surgery, and reconstruction. Pain management, physical rehabilitation, and close neurological follow-up are imperative to near-total recovery. Aggressive VHs are most commonly seen in the thoracic region but may rarely involve a large number of vertebrae. Cutaneous hemangiomas, when seen along with VHs, are often metameric. We present a rare and challenging case of compressive myelopathy and a large cutaneous hemangioma or a "purple shoulder", found during an exam in a young male. He was found to have an extensive VH extending through 13 vertebral levels (C7 to D12), non-metameric to the cutaneous lesion. A thorough physical examination and evaluation along with prompt surgical treatment were the cornerstone of treatment and prevention of permanent neurological deficits.

Research paper thumbnail of Pain characteristics in Parkinson's disease: An Indian experience

Background & Objective: Parkinson’s disease (PD) is a chronic neurological disease, many a times ... more Background & Objective: Parkinson’s disease (PD) is a chronic neurological disease, many a times presenting with non-motor symptoms. Pain is one of the most important non-motor symptom and there is no consensus regarding its exact mechanism and characterisation. This study was planned to evaluate the characteristics of pain and possible factors influencing it, in a cohort of patients with established Parkinson’s disease. Methods: 104 patients consenting to participate were included in the study. Data regarding age of onset, duration of disease, treatment, Hoehn-Yahr scale, phenotype of PD, UPDRS scores, pain type and distribution of pain were noted. Single and multiple logistical regression models with pain (1/0) as the outcome variable were used to check the association of pain with the above mentioned variables. Results: 54.8% of patients with PD experience pain. Presence of sensory symptoms was significantly associated with the pain group (42.1%) than the no pain group (21%). Pai...

Research paper thumbnail of Parkinson's disease in intensive care unit: An observational study of frequencies, causes, and outcomes

Annals of Indian Academy of Neurology, 2019

Objective: To analyze the frequency, causes, and outcomes of admission to the Intensive Care Unit... more Objective: To analyze the frequency, causes, and outcomes of admission to the Intensive Care Unit (ICU) among Parkinson's disease (PD) population so that preventive measures can be developed. Methods: We prospectively observed patients with diagnosis of PD admitted to ICU from January 2014 to December 2016. Based on etiology for hospital admission, they were divided into two groups – related to PD (further divided into direct or indirect) or not associated with PD at all. Etiology for hospitalization was determined from history and investigational data. The primary outcome was death or discharge from the hospital. Factors contributing to ICU admission were analyzed by comparing these patients with a cohort of 50 PD patients admitted to the neurology ward during the same study period. All values were expressed as mean (standard deviation) and percentages using SPSS version 16.0. Results: Fifty-three (36%) out of a total of 146 patients required ICU admission. Most common causes leading to admission in decreasing order of frequency were fever (34%), delirium (16%), falls (12%), encephalopathy (8%), gastrointestinal emergencies (6%); while direct disease-related severe dyskinesias were seen only in two patients (4%). 13.7% needed mechanical ventilation and mean duration of ventilation was 5.94 days with mortality rate of 20%. Significant factors predicting ICU admission, and thus, poor outcomes were age >65 years, history of previous admission within the last 12 months, delirium, and hypoalbuminemia. There was no significant association between the incidence of ICU admission and duration of disease or severity of the disease. Conclusions: Poor outcome in PD patients is due to systemic causes, hence multidisciplinary teamwork may improve outcome in these patients.

Research paper thumbnail of Multiple Sclerosis Relapse Presenting as Sensorineural Hearing Loss

Research paper thumbnail of Decompressive craniectomy in malignant middle cerebral artery infarct: An institutional experience

Asian journal of neurosurgery, Sep 1, 2015

The purpose of this article was to share author's experience with decompressive craniectomy in ma... more The purpose of this article was to share author's experience with decompressive craniectomy in malignant middle cerebral artery (MCA) infarct with special emphasis on patients older than 60 years and those operated outside 48 h after onset of stroke. The surgical procedure involves temporarily removal of a large segment of the cranium (fragments of frontal, temporal, and parietal bones) followed by opening of dura in order to provide extra space into which the injured or ischemic brain can expand. Decompressive craniectomy has largely replaced the removal of brain tissue (i.e. lobectomy) as the preferred surgical option. [1] The concept of decompression first introduced by Annandale in late 1890. Later, Kocher in 1901 and Harvey Cushing in 1905 proposed decompressive craniectomy for relieving raised intracranial pressure. Unfortunately, technique got limited due to poor esthetical results. [2] The landmark work of Guerra et al. (decompressive craniectomy for traumatic brain swelling) established the procedure as an appropriate therapy for refractory intracranial pressure (ICP) of any origin in 1999. [3] We present out the experience of decompressive craniectomy in last 2½ years in malignant MCA infarct.

Research paper thumbnail of Clinical predictors of mechanical ventilation in Guillain-Barré syndrome

Neurology India, 2012

Patients with Guillain-Barré syndrome (GBS) require assisted ventilation frequently. However, no ... more Patients with Guillain-Barré syndrome (GBS) require assisted ventilation frequently. However, no single factor can predict ventilator requirement. To identify clinical variables which could predict the need for mechanical ventilation in GBS. Tertiary hospital-based retrospective and prospective study. One hundred and thirty-eight GBS patients studied were divided into two groups ventilated (Group 1) and non-ventilated (Group 2). Parameters assessed included age, gender, associated illness(es), antecedent events, first symptom at onset, time from onset to bulbar involvement, confinement to bed and peak disability, upper limb power and reflexes at nadir, presence of facial weakness, neck muscle weakness and autonomic dysfunction. Multivariate predictors of ventilation were assessed using logistic regression analysis. There were 53 patients in Group 1 and 85 in Group 2. The mean age in the two groups was comparable. On bivariate analysis, simultaneous weakness of upper (UL) and lower (LL) limbs as the initial symptom (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001); UL power less than Grade 3/5 at nadir (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001); presence of neck and bulbar weakness (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001); shorter duration from onset to bulbar weakness and confinement to bed (P=0.001) and bilateral facial involvement (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) were more frequently associated with the need for ventilation. Preserved reflexes in UL at nadir was significantly associated with absence of the need for mechanical ventilation (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). On multivariate analysis, factors independently associated with the need for mechanical ventilation included simultaneous motor weakness in UL and LL as the initial symptom (P=0.02), UL power&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;3/5 (Medical Research Council grade) at nadir (P=0.013) and presence of bulbar weakness…

Research paper thumbnail of Author Response: Multiple Sclerosis Relapse Presenting as Sensorineural Hearing Loss

Research paper thumbnail of An Emergency Message and Call System for People with Epilepsy

2022 IEEE International Instrumentation and Measurement Technology Conference (I2MTC), May 16, 2022

Research paper thumbnail of Multi-parameter Wearable Band for Wireless Data Collection from People with Epilepsy

2022 IEEE International Instrumentation and Measurement Technology Conference (I2MTC), May 16, 2022

Research paper thumbnail of An Uncommon Case of Celiac Disease and Deep Cerebral Venous Sinus Thrombosis

Journal of Neurosciences in Rural Practice

Celiac disease is an enteropathy characterized by malabsorption related with gluten intolerance a... more Celiac disease is an enteropathy characterized by malabsorption related with gluten intolerance and immune-mediated pathogenesis. It may manifest with gastrointestinal features like diarrhea, abdominal pain, weight loss, and anemia. Besides, it can manifest with various extraintestinal features like ataxia, neuropathy, stroke, or sometimes venous sinus thrombosis. Being of autoimmune origin, relation with systemic lupus erythematosus has also been reported. Herein, we present a rare case of a young patient with celiac disease who presented with fever, headache, and altered sensorium and was found to have meningitis with deep cerebral venous sinus thrombosis.

Research paper thumbnail of Abstract 14683: Efficacy of Sovateltide (PMZ-1620), a First-in-Class Neuronal Progenitor Cell Therapeutics, in Patients With Cerebral Ischemic Stroke

Circulation, Nov 19, 2019

Research paper thumbnail of Etiology and Pathogenesis of Parkinson's Disease

Annual Review of Neuroscience, 1999

▪ Parkinson's disease (PD) is an age-related neurodegenerative disorder that affects approx... more ▪ Parkinson's disease (PD) is an age-related neurodegenerative disorder that affects approximately 1 million persons in the United States. It is characterized by resting tremor, rigidity, bradykinesia or slowness, gait disturbance, and postural instability. Pathological features include degeneration of dopaminergic neurons in the substantia nigra pars compacta coupled with intracytoplasmic inclusions known as Lewy bodies. Neurodegeneration and Lewy bodies can also be found in the locus ceruleus, nucleus basalis, hypothalamus, cerebral cortex, cranial nerve motor nuclei, and central and peripheral components of the autonomic nervous system. Current treatment consists of a dopamine replacement strategy using primarily the dopamine precursor levodopa. While levodopa provides benefit to virtually all PD patients, after 5–10 years of treatment the majority of patients develop adverse events in the form of dyskinesia (involuntary movements) and fluctuations in motor response. Furthe...

Research paper thumbnail of To study the medication adherence patterns in Parkinson's disease and it's impact on quality of life

Parkinsonism & Related Disorders, Oct 1, 2020

Research paper thumbnail of Gender Differences in Impulse Control Disorders and Related Behaviors in Patients with Parkinson's Disease and its Impact on Quality of Life

Annals of Indian Academy of Neurology

Background: Dopaminergic medications administered to remedy motor symptoms in Parkinson’s disease... more Background: Dopaminergic medications administered to remedy motor symptoms in Parkinson’s disease are associated with an enhanced risk for impulse control disorders (ICD) and related compulsive behaviors (ICD-RB). Thus, the present study focuses on investigating the gender difference in the prevalence of ICD-RBs in Indian PD patients on dopamine replacement therapy (DRT), its impact on quality of life and to identify ICDs relevant in Indian scenario apart from the criteria set in QUIP-RS. Method: This was a hospital-based observational cross-sectional study in which Parkinson’s disease patients attending neurology clinic were included. Complete details of anti-parkinsonian therapy along with demographic and clinical variables were recorded on a predesigned Performa. Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s disease (QUIP), which is a validated quick screening tool, was used to detect ICD-RBs. The relative frequency and comparative impact of ICD on health-related quality of life (QOL) was studied using validated PDQ-39 Questionnaire. Results: Out of 102 patients, at least one ICD or ICD-RB was present in 41.19% and ≥2 ICD-RBs were present in 15.59%. At least one ICD was present in 16.67%, any ICD-related compulsive behaviors was present in 34.31% patients. The most common was punding and compulsive medication use (12.75% each), followed by hobbyism (7.84%), compulsive eating (6.86%), pathological gambling (3.92%), and hypersexuality, walkabout, and compulsive shopping (2.94% each). ICDs not classified elsewhere such as trichotillomania were found 3 patients (2.94%). ICD-RBs showed a trend to be more frequent in women (44.82% women vs. 39.39% men). As compared with patients without ICD-RBs, those with ICD-RBs were found to have higher dose of LD and DA and higher Hoehn and Yahr stage. ICD-RBs have a negative impact on the quality of life of Parkinson’s disease patients. Conclusion: ICDs and ICD-RBs have been included in the behavioral spectrum of nonmotor symptoms in PD. PD patients are at increased risk of developing ICD-RBs which interfere with important activities and have obligation in ordinary life, leading to legal and psychological consequences with a great impact on QOL.

Research paper thumbnail of Clinical Challenge: Dural Arteriovenous Fistula Presenting as Venous Encephalopathy

Neurology India, Jul 23, 2022

Research paper thumbnail of A cluster‐randomized trial comparing home‐based primary health care and usual clinic care for epilepsy in a resource‐limited country

Epilepsia Open

This is an open access article under the terms of the Creative Commons Attribution License, which... more This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Research paper thumbnail of SARS-CoV-19-associated Rhino-orbital and cerebral mucormycosis: clinical and radiological presentations

Medical Mycology

We describe presenting clinical and imaging manifestations of severe acute respiratory syndrome c... more We describe presenting clinical and imaging manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated Rhino-oculo-cerebral mucormycosis (ROCM) in a hospital setting during the second wave of SARS-CoV-2 pandemic in India. Data on the presenting manifestations were collected from 1 March to 31 May 2021. Associations between clinical and imaging findings were explored, specifically: (1) the presence or absence of orbital pain and infiltration of a superior orbital fissure on imaging; (2) the presence of unilateral facial nerve palsy and pterygopalatine fossa infiltration and geniculate ganglion signal on contrast magnetic resonance imaging, and (3) vision loss and optic nerve findings on imaging. Orbital pain was reported by 6/36 subjects. A fixed, frozen eye with proptosis and congestion was documented in 26 (72%), complete vision loss in 23 (64%), and a unilateral lower motor neuron facial nerve palsy in 18 (50%). No association was found between the p...

Research paper thumbnail of Analysis of trimodal pattern of mortality among hospitalized COVID-19 patients- Lessons from tertiary care hospital

Journal of Anaesthesiology Clinical Pharmacology

Research paper thumbnail of Neuropathy in Parkinson's disease: Risk determinants and impact on quality of life

Annals of Indian Academy of Neurology

Research paper thumbnail of Factors affecting adherence to pharmacotherapy in parkinson's disease

Annals of Indian Academy of Neurology, 2021

Background: The goal of dopaminergic replacement therapy to achieve good clinical outcome in Park... more Background: The goal of dopaminergic replacement therapy to achieve good clinical outcome in Parkinson's disease (PD) patients largely depends on the pattern of adherence to the pharmacological treatment. This study aims to find the factors affecting medication adherence in patients with PD keeping in mind the cultural, economic, and social diversities so that preventive steps can be taken to fill these gaps.Methods: Demographic data, disease parameters, treatment-related factors, family characteristics, educational, and employment status were assessed for relationship with the medication adherence pattern in a cohort of non-demented PD patients. Medication adherence was measured by MMAS-8; depression, and socioeconomic status were assessed by GDS-SF and Kuppuswamy scales respectively. Results: From 134 PD subjects, high adherence was observed in 43.2%, 18.2% had moderate, and 38.6% reported low adherence level to their pharmacotherapy. The sub-optimal level of adherence was significantly correlated to compliance of follow up with the physician (p 0.03), presence of adverse events related to drugs (p 0.03), and depressive symptoms (p < 0.0001). Also, there was significant negative co-relationship between poor adherence and depression on Spearman's rank coefficient (0.702). There was no effect of demographic factors, living conditions, family type, educational qualification, associated comorbid conditions, and socioeconomic status on adherence to dopaminergic treatment in patients with PD. Conclusion: Poor adherence to prescribed medication is a menace that is more than just oversimplification of forgetfulness which should be evaluated at each visit to improve efficacy of the prescribed regimen to achieve better treatment result and thus quality of life of PD patients.

Research paper thumbnail of Aggressive Vertebral Hemangioma: The Mystery of Spastic Legs Unveiled by a Purple Shoulder

Cureus, 2022

Vertebral hemangiomas (VHs) are benign vascular tumors that develop from the endoderm of blood ve... more Vertebral hemangiomas (VHs) are benign vascular tumors that develop from the endoderm of blood vessels, although their exact pathogenesis is poorly understood. Most hemangiomas are small, about a third are multiple in number, and a very small number of these hemangiomas cause symptoms. Even more rare are aggressive VHs, which comprise a small number of all VHs, and are associated with expansion and extraosseous extension into the paraspinal and epidural spaces. Management of aggressive VHs involve preop embolization, spinal surgery, and reconstruction. Pain management, physical rehabilitation, and close neurological follow-up are imperative to near-total recovery. Aggressive VHs are most commonly seen in the thoracic region but may rarely involve a large number of vertebrae. Cutaneous hemangiomas, when seen along with VHs, are often metameric. We present a rare and challenging case of compressive myelopathy and a large cutaneous hemangioma or a "purple shoulder", found during an exam in a young male. He was found to have an extensive VH extending through 13 vertebral levels (C7 to D12), non-metameric to the cutaneous lesion. A thorough physical examination and evaluation along with prompt surgical treatment were the cornerstone of treatment and prevention of permanent neurological deficits.

Research paper thumbnail of Pain characteristics in Parkinson's disease: An Indian experience

Background & Objective: Parkinson’s disease (PD) is a chronic neurological disease, many a times ... more Background & Objective: Parkinson’s disease (PD) is a chronic neurological disease, many a times presenting with non-motor symptoms. Pain is one of the most important non-motor symptom and there is no consensus regarding its exact mechanism and characterisation. This study was planned to evaluate the characteristics of pain and possible factors influencing it, in a cohort of patients with established Parkinson’s disease. Methods: 104 patients consenting to participate were included in the study. Data regarding age of onset, duration of disease, treatment, Hoehn-Yahr scale, phenotype of PD, UPDRS scores, pain type and distribution of pain were noted. Single and multiple logistical regression models with pain (1/0) as the outcome variable were used to check the association of pain with the above mentioned variables. Results: 54.8% of patients with PD experience pain. Presence of sensory symptoms was significantly associated with the pain group (42.1%) than the no pain group (21%). Pai...

Research paper thumbnail of Parkinson's disease in intensive care unit: An observational study of frequencies, causes, and outcomes

Annals of Indian Academy of Neurology, 2019

Objective: To analyze the frequency, causes, and outcomes of admission to the Intensive Care Unit... more Objective: To analyze the frequency, causes, and outcomes of admission to the Intensive Care Unit (ICU) among Parkinson's disease (PD) population so that preventive measures can be developed. Methods: We prospectively observed patients with diagnosis of PD admitted to ICU from January 2014 to December 2016. Based on etiology for hospital admission, they were divided into two groups – related to PD (further divided into direct or indirect) or not associated with PD at all. Etiology for hospitalization was determined from history and investigational data. The primary outcome was death or discharge from the hospital. Factors contributing to ICU admission were analyzed by comparing these patients with a cohort of 50 PD patients admitted to the neurology ward during the same study period. All values were expressed as mean (standard deviation) and percentages using SPSS version 16.0. Results: Fifty-three (36%) out of a total of 146 patients required ICU admission. Most common causes leading to admission in decreasing order of frequency were fever (34%), delirium (16%), falls (12%), encephalopathy (8%), gastrointestinal emergencies (6%); while direct disease-related severe dyskinesias were seen only in two patients (4%). 13.7% needed mechanical ventilation and mean duration of ventilation was 5.94 days with mortality rate of 20%. Significant factors predicting ICU admission, and thus, poor outcomes were age >65 years, history of previous admission within the last 12 months, delirium, and hypoalbuminemia. There was no significant association between the incidence of ICU admission and duration of disease or severity of the disease. Conclusions: Poor outcome in PD patients is due to systemic causes, hence multidisciplinary teamwork may improve outcome in these patients.