Hrishikesh Kumar - Academia.edu (original) (raw)

Papers by Hrishikesh Kumar

Research paper thumbnail of Inflammasome and α-synuclein in Parkinson's disease: A cross-sectional study

Journal of Neuroimmunology, 2019

Background: Alpha-synuclein and inflammatory pathology are evident in Parkinson's disease (PD) bu... more Background: Alpha-synuclein and inflammatory pathology are evident in Parkinson's disease (PD) but, their link to disease pathogenesis needs further elucidation. Objectives: To explore α-synuclein-mediated inflammation in the serum of PD patients and its link with disease severity. Methods: Serum levels of IL-1β, NLRP3, total and phosphorylated α-synuclein were compared. Results: IL-1β, NLRP3 levels were significantly increased in PD. We also observed a linear correlation of NLRP3 with α-synuclein. Phosphorylated α-synuclein levels were significantly elevated in later stages of PD. Conclusions: The α-synuclein-NLRP3 mediated inflammation may underline the pathophysiology of PD and might serve as a novel therapeutic target in PD.

Research paper thumbnail of Botulinum Toxin Injection in Truncal Dystonia: Time to Take Note

Annals of Indian Academy of Neurology

579 Truncal dystonia leads to significant distress to the patient and poses difficult therapeutic... more 579 Truncal dystonia leads to significant distress to the patient and poses difficult therapeutic challenge to clinicians. Truncal dystonia is not rare but surprisingly, there is not enough data available to guide an approach to diagnosis or treatment. Camptocormia (flexion dystonia of trunk) was found in 7% of patients with Parkinson’s disease and the prevalence increases with the severity of the disease.[1] As high as 26% of patients with multiple system atrophy reportedly present with Pisa syndrome (lateral truncal flexion).[2] 17% of progressive supranuclear palsy patients reported to have axial dystonia in extension.[3] Patients with tardive syndrome, Wilson’s disease, neurodegeneration with brain iron accumulation, and some other genetic form of dystonia may have prominent truncal involvement. A subset of patients presents with isolated idiopathic truncal dystonia.

Research paper thumbnail of Teaching Video NeuroImage: Pendular Vertical Oscillations in a Young Adult With a Pontine Hemorrhage

Research paper thumbnail of Is peripheral alpha synuclein a marker for gait velocity in Parkinson’s disease?

Research paper thumbnail of Genome‐Wide Polygenic Score Predicts Large Number of High Risk Individuals in Monogenic Undiagnosed Young Onset Parkinson's Disease Patients from India

Advanced Biology

Parkinson's disease (PD) is a genetically heterogeneous neurodegenerative disease with poorly... more Parkinson's disease (PD) is a genetically heterogeneous neurodegenerative disease with poorly defined environmental influences. Genomic studies of PD patients have identified disease‐relevant monogenic genes, rare variants of significance, and polygenic risk‐associated variants. In this study, whole genome sequencing data from 90 young onset Parkinson's disease (YOPD) individuals are analyzed for both monogenic and polygenic risk. The genetic variant analysis identifies pathogenic/likely pathogenic variants in eight of the 90 individuals (8.8%). It includes large homozygous coding exon deletions in PRKN and SNV/InDels in VPS13C, PLA2G6, PINK1, SYNJ1, and GCH1. Eleven rare heterozygous GBA coding variants are also identified in 13 (14.4%) individuals. In 34 (56.6%) individuals, one or more variants of uncertain significance (VUS) in PD/PD‐relevant genes are observed. Though YOPD patients with a prioritized pathogenic variant show a low polygenic risk score (PRS), patients wit...

Research paper thumbnail of Short-Latency Afferent Inhibition Correlates with Stage of Disease in Parkinson’s Patients

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques

ABSTRACT:Background:Sensory-motor decoupling at the cortical level involving cholinergic circuitr... more ABSTRACT:Background:Sensory-motor decoupling at the cortical level involving cholinergic circuitry has also been reported in Parkinson’s Disease (PD). Short-latency afferent inhibition (SAI) is a transcranial magnetic stimulation (TMS) paradigm that has been used previously to probe cortical cholinergic circuits in well-characterised subgroups of patients with PD. In the current study, we compared SAI in a cohort of PD patients at various stages of disease and explored correlations between SAI and various clinical measures of disease severity.Methods:The modified Hoehn and Yahr (H&Y) scale was used to stage disease in 22 patients with PD. Motor and cognitive function were assessed using the MDS-UPDRS (Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale) part III and MoCA (Montreal Cognitive Assessment) score, respectively. Objective gait assessment was performed using an electronic walkway (GAITRite®). SAI was measured as the average percenta...

Research paper thumbnail of Clinical Study of 668 Indian Subjects with Juvenile, Young, and Early Onset Parkinson’s Disease

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 2021

ABSTRACT:Objective:To determine the demographic pattern of juvenile-onset parkinsonism (JP, <2... more ABSTRACT:Objective:To determine the demographic pattern of juvenile-onset parkinsonism (JP, <20 years), young-onset (YOPD, 20–40 years), and early onset (EOPD, 40–50 years) Parkinson’s disease (PD) in India.Materials and Methods:We conducted a 2-year, pan-India, multicenter collaborative study to analyze clinical patterns of JP, YOPD, and EOPD. All patients under follow-up of movement disorders specialists and meeting United Kingdom (UK) Brain Bank criteria for PD were included.Results:A total of 668 subjects (M:F 455:213) were recruited with a mean age at onset of 38.7 ± 8.1 years. The mean duration of symptoms at the time of study was 8 ± 6 years. Fifteen percent had a family history of PD and 13% had consanguinity. JP had the highest consanguinity rate (53%). YOPD and JP cases had a higher prevalence of consanguinity, dystonia, and gait and balance issues compared to those with EOPD. In relation to nonmotor symptoms, panic attacks and depression were more common in YOPD and sl...

Research paper thumbnail of Effect of mask on doctor–Patient relationship during COVID-19: Indian perspective

Annals of Indian Academy of Neurology, 2021

Research paper thumbnail of Efficacy and Safety of Ticagrelor and Aspirin in Patients With Moderate Ischemic Stroke

JAMA Neurology, 2021

Prior trials of dual antiplatelet therapy excluded patients with moderate ischemic stroke. These ... more Prior trials of dual antiplatelet therapy excluded patients with moderate ischemic stroke. These patients were included in the Acute Stroke or Transient Ischaemic Attack Treated With Ticagrelor and ASA for Prevention of Stroke and Death (THALES) trial, but results have not been reported separately, raising concerns about safety and efficacy in this subgroup. OBJECTIVE To evaluate the efficacy and safety of ticagrelor plus aspirin in patients with moderate ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score of 4 to 5). DESIGN, SETTING, AND PARTICIPANTS The THALES trial was a randomized trial conducted at 414 hospitals in 28 countries in January 2018 and December 2019. This exploratory analysis compared patients with moderate stroke (baseline NIHSS score of 4 to 5) with patients with less severe stroke (NIHSS score of 0 to 3). A total of 9983 patients with stroke were included in the present analysis, after excluding 2 patients with NIHSS scores greater than 5 and 1031 patients with transient ischemic attack. Data were analyzed from March to April 2021. INTERVENTIONS Ticagrelor (180-mg loading dose on day 1 followed by 90 mg twice daily on days 2 to 30) or placebo within 24 hours after symptom onset. All patients received aspirin, 300 to 325 mg, on day 1 followed by aspirin, 75 to 100 mg, daily on days 2 to 30. Patients were observed for 30 additional days. MAIN OUTCOMES AND MEASURES The primary outcome was time to stroke or death within 30 days. The primary safety outcome was time to severe bleeding. RESULTS In total, 3312 patients presented with moderate stroke and 6671 presented with less severe stroke. Of those in the moderate stroke group, 1293 (39.0%) were female, and the mean (SD) age was 64.5 (10.8) years; of those in the less severe stroke group, 2518 (37.7%) were female, and the mean (SD) age was 64.8 (11.2) years. The observed primary outcome event rate in patients with moderate stroke was 7.6% (129 of 1671) for those in the ticagrelor group and 9.1% (150 of 1641) for those in the placebo group (hazard ratio, 0.84; 95% CI, 0.66-1.06); the primary outcome event rate in patients with less severe stroke was 4.7% (158 of 3359) for those in the ticagrelor group and 5.7% (190 of 3312) for those in the placebo group (hazard ratio, 0.82; 95% CI, 0.66-1.01) (P for interaction = .88). Severe bleeding occurred in 8 patients (0.5%) in the ticagrelor group and in 4 patients (0.2%) in the placebo group in those with moderate stroke compared with 16 patients (0.5%) and 3 patients (0.1%), respectively, with less severe stroke (P for interaction = .26). CONCLUSIONS AND RELEVANCE In this study, patients with a moderate ischemic stroke had consistent benefit from ticagrelor plus aspirin vs aspirin alone compared with patients with less severe ischemic stroke, with no further increase in the risk of intracranial bleeding or other severe bleeding events. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03354429

Research paper thumbnail of Dance movement therapy in rehabilitation of Parkinson's disease – A feasibility study

Journal of Bodywork and Movement Therapies, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of A longitudinal quantitative analysis of gait in patients with SCA-12

Clinical Parkinsonism & Related Disorders, 2021

Spinocerebellar ataxia type 12 (SCA 12) is characterized by late onset tremor, ataxia and pyramid... more Spinocerebellar ataxia type 12 (SCA 12) is characterized by late onset tremor, ataxia and pyramidal signs. Parkinsonism and cognitive decline may appear with time. It is considered as slowly progressive but temporal evolution of symptoms has not been reported. Method: We report the evolution of symptoms in three SCA12 patients followed over a range of 5-6 years. We focused on the evolution of gait abnormality as it becomes the most disabling symptom as disease advances. Twodimensional gait parameters were studied using an electronic walkway at various time points to measure objective changes in gait. Result: All patients presented with tremor in the upper extremity at baseline which progressed non-uniformly over the years. Progression of gait variability measures of step length, stance time and step time were also observed. Conclusion: Gait characteristics such as variability may precede clinical gait abnormality and could serve as a sensitive marker for disease progression for better therapeutic intervention in disease management. Future studies with larger sample size should be undertaken to conclusively validate this observation.

Research paper thumbnail of Pattern Specific Dysgraphia—Beyond Letter Specificity

Movement Disorders Clinical Practice

Research paper thumbnail of Impact of COVID‐19 on Patient Care, Training, and Research in Movement Disorders in MDS‐AOS Region

Movement Disorders, 2021

The COVID-19 pandemic has caused disruptions in movement disorder clinical services and education... more The COVID-19 pandemic has caused disruptions in movement disorder clinical services and education. 1-5 The Movement Disorder Society-Asian and Oceanian Section (MDS-AOS) is a subsection of the MDS comprised of 41 countries and territories, with diverse socioeconomic backgrounds, health care systems, and varied exposure to prior pandemics. To determine the impact of the pandemic on clinical, training, and research activities of movement disorders, a structured questionnaire was developed with expert consensus during a conference call organized by the MDS-AOS. Fifteen months into the pandemic, that is, March 2021, members of the MDS-AOS were invited to participate in an online survey. The impact of the pandemic was graded from zero to five (zero: "no impact," five: "total disruption"), and responses were recorded over five time points. Seventy-four responses were received from 20 countries, with the majority (36%, n = 27) from India (Supplementary Material).

Research paper thumbnail of Impact of Home Confinement During the COVID‐19 Pandemic on Medication Use and Disease Activity in Spondyloarthritis Patients

Arthritis & Rheumatology, 2020

Impact of home confinement during the COVID-19 pandemic on medication use and disease activity in... more Impact of home confinement during the COVID-19 pandemic on medication use and disease activity in spondyloarthritis patients To the Editor: Home confinement, imposed as part of the social distancing measures in the fight against coronavirus disease 2019 (COVID-19), poses several problems for patients with spondyloarthritis (SpA), including the lack of physical activity (1), psychological factors, and confusion related to the prescriptions of nonsteroidal antiinflammatory drugs (NSAIDs) (2). We investigated the impact of confinement on medication use and disease activity in patients with SpA, using a questionnaire-based survey. Between April 10 and April 21, 2020, a questionnaire was administered to 1,656 members of a private social network of the Association Contre les Spondylarthrites (ACS). The questionnaire, created using Microsoft form software, included questions on age, SpA type, treatment with NSAIDs and biologic agents and their modifications, onset of flares, and infections including COVID-19. A written explanation of the study aim was provided with the questionnaire. The study protocol was approved by the National Ethics Commission (Clinicaltrials.gov identifier: NCT04355923). Overall, 609 (37%) of the 1,656 members of the ACS responded to the questionnaire. Patient characteristics and responses regarding treatment modification are shown in Table 1. From our survey, 382 of 609 subjects (63%) reported experiencing worsening disease during confinement, and 108 (28%) experienced considerable deterioration. Worsening of symptoms was significantly associated with treatment modification (P = 0.001). The number and severity of crises were greater during the confinement (of 512 patients with available information, 251 [49%] with severe flares during confinement versus 100 [20%] with severe flares before confinement [P < 0.001]). Further, 88 subjects (14%) reported experiencing an infectious disease during the confinement. The occurrence of infection was associated with treatment modification (P < 0.001), particularly when the infection was COVID-19 (P < 0.001). The frequency of COVID-19 infection in patients treated with biologic disease-modifying antirheumatic drug (DMARDs) or NSAIDs was not higher than that in subjects without such treatment (P = 0.6 and P = 0.4, respectively). The COVID-19 pandemic and the resulting confinement had significant consequences in this SpA population, with 47% of patients having changed their treatment. The majority of treatment changes were observed in patients who had been regularly

Research paper thumbnail of Validity, Reliability, and Insights from Applying the McGill Quality of Life Questionnaire to People Living with Parkinson's Disease (MQoL-PD)

Journal of palliative care, 2015

Existing quality-of-life instruments for Parkinson's disease (PD) may not fully assess qualit... more Existing quality-of-life instruments for Parkinson's disease (PD) may not fully assess quality of life (QoL) for people with PD in a holistic and multidimensional manner. This study examines the subscale structure, validity, and internal-consistency reliability of the McGill Quality of Life (MQoL) Questionnaire in a sample of people with PD. This cross-sectional study evaluates the MQoL-PD by using Cronbach's alpha and principal components analysis. A total of 81 consenting people with PD from a tertiary care outpatient clinic were studied. Scores were tabulated for the motor Unified Parkinson's Disease Rating Scale (mUPDRS), the Short Form Health Survey (SF-36), the Parkinson's Disease Questionnaire (PDQ-39), the MQoL Single-Item Scale (MQoL-SIS), and the MQoL Questionnaire (MQoL). Cronbach's alpha for the MQoL-PD was: physical symptoms, 0.83; psychological symptoms, 0.59; and existential/support symptoms, 0.76. Important contributors to QoL in PD include mobili...

Research paper thumbnail of Gait analysis in Parkinson’s disease assessing the effect of levodopa using a validated electronic walkway

Parkinsonism & Related Disorders, 2016

Research paper thumbnail of Ticagrelor Added to Aspirin in Acute Ischemic Stroke or Transient Ischemic Attack in Prevention of Disabling Stroke

JAMA Neurology, 2021

IMPORTANCE Reduction of subsequent disabling stroke is the main goal of preventive treatment in t... more IMPORTANCE Reduction of subsequent disabling stroke is the main goal of preventive treatment in the acute setting after transient ischemic attack (TIA) or minor ischemic stroke. OBJECTIVE To evaluate the superiority of ticagrelor added to aspirin in preventing disabling stroke and to understand the factors associated with recurrent disabling stroke. DESIGN, SETTING, AND PARTICIPANTS The Acute Stroke or Transient Ischemic Attack Treated With Ticagrelor and Aspirin for Prevention of Stroke and Death (THALES) was a randomized clinical trial conducted between January 22, 2018, and December 13, 2019, with a 30-day follow-up, at 414 hospitals in 28 countries. The trial included 11 016 patients with a noncardioembolic, nonsevere ischemic stroke or high-risk TIA, including 10 803 with modified Rankin Scale score (mRS) recorded at 30 days. INTERVENTIONS Ticagrelor (180-mg loading dose on day 1 followed by 90 mg twice daily for days 2-30) or placebo within 24 hours of symptom onset. All patients received aspirin, 300 to 325 mg on day 1 followed by 75 to 100 mg daily for days 2 to 30. MAIN OUTCOMES AND MEASURES Time to the occurrence of disabling stroke (progression of index event or new stroke) or death within 30 days, as measured by mRS at day 30. Disabling stroke was defined by mRS greater than 1. RESULTS Among participants with 30-day mRS greater than 1, mean age was 68.1 years, 1098 were female (42.6%), and 2670 had an ischemic stroke (95.8%) as a qualifying event. Among 11 016 patients, a primary end point with mRS greater than 1 at 30 days occurred in 221 of 5511 patients (4.0%) randomized to ticagrelor and in 260 of 5478 patients (4.7%) randomized to placebo (hazard ratio [HR], 0.83; 95% CI, 0.69-0.99, P = .04). A primary end point with mRS 0 or 1 at 30 days occurred in 70 of 5511 patients (1.3%) and 87 of 5478 patients (1.6%) (HR, 0.79; 95% CI, 0.57-1.08; P = .14). The ordinal analysis of mRS in patients with recurrent stroke showed a shift of the disability burden following a recurrent ischemic stroke in favor of ticagrelor (odds ratio, 0.77; 95% CI, 0.65-0.91; P = .002). Factors associated with disability were baseline National Institutes of Health Stroke Scale score 4 to 5, ipsilateral stenosis of at least 30%, Asian race/ethnicity, older age, and higher systolic blood pressure, while treatment with ticagrelor was associated with less disability. CONCLUSIONS AND RELEVANCE In patients with TIA and minor ischemic stroke, ticagrelor added to aspirin was superior to aspirin alone in preventing disabling stroke or death at 30 days and reduced the total burden of disability owing to ischemic stroke recurrence. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03354429

Research paper thumbnail of Asymmetry of Tremor in Spinocerebellar Ataxia 12‐ Exception or Rule?

Movement Disorders Clinical Practice, 2021

Research paper thumbnail of Supppl_doc – Supplemental material for A Novel Wearable Device for Motor Recovery of Hand Function in Chronic Stroke Survivors

Supplemental material, Supppl_doc for A Novel Wearable Device for Motor Recovery of Hand Function... more Supplemental material, Supppl_doc for A Novel Wearable Device for Motor Recovery of Hand Function in Chronic Stroke Survivors by Supriyo Choudhury, Ravi Singh, A. Shobhana, Dwaipayan Sen, Sidharth Shankar Anand, Shantanu Shubham, Suparna Gangopadhyay, Mark R. Baker, Hrishikesh Kumar and Stuart N. Baker in Neurorehabilitation and Neural Repair

Research paper thumbnail of Neuroimaging Pearls from the MDS Congress Video Challenge. Part 1: Genetic Disorders

Movement Disorders Clinical Practice, 2022

We selected several "imaging pearls" presented during the Movement Disorder Society (MDS) Video C... more We selected several "imaging pearls" presented during the Movement Disorder Society (MDS) Video Challenge for this review. While the event, as implicated by its name, was video-centered, we would like to emphasize the important role of imaging in making the correct diagnosis. We divided this anthology into two parts: genetic and acquired disorders. Genetic cases described herein were organized by the inheritance pattern and the focus was put on the imaging findings and differential diagnoses. Despite the overlapping phenotypes, certain described disorders have pathognomonic MRI brain findings that would provide either the "spot" diagnosis or result in further investigations leading to the diagnosis. Despite this, the diagnosis is often challenging with a broad differential diagnosis, and hallmark findings may be present for only a limited time.

Research paper thumbnail of Inflammasome and α-synuclein in Parkinson's disease: A cross-sectional study

Journal of Neuroimmunology, 2019

Background: Alpha-synuclein and inflammatory pathology are evident in Parkinson's disease (PD) bu... more Background: Alpha-synuclein and inflammatory pathology are evident in Parkinson's disease (PD) but, their link to disease pathogenesis needs further elucidation. Objectives: To explore α-synuclein-mediated inflammation in the serum of PD patients and its link with disease severity. Methods: Serum levels of IL-1β, NLRP3, total and phosphorylated α-synuclein were compared. Results: IL-1β, NLRP3 levels were significantly increased in PD. We also observed a linear correlation of NLRP3 with α-synuclein. Phosphorylated α-synuclein levels were significantly elevated in later stages of PD. Conclusions: The α-synuclein-NLRP3 mediated inflammation may underline the pathophysiology of PD and might serve as a novel therapeutic target in PD.

Research paper thumbnail of Botulinum Toxin Injection in Truncal Dystonia: Time to Take Note

Annals of Indian Academy of Neurology

579 Truncal dystonia leads to significant distress to the patient and poses difficult therapeutic... more 579 Truncal dystonia leads to significant distress to the patient and poses difficult therapeutic challenge to clinicians. Truncal dystonia is not rare but surprisingly, there is not enough data available to guide an approach to diagnosis or treatment. Camptocormia (flexion dystonia of trunk) was found in 7% of patients with Parkinson’s disease and the prevalence increases with the severity of the disease.[1] As high as 26% of patients with multiple system atrophy reportedly present with Pisa syndrome (lateral truncal flexion).[2] 17% of progressive supranuclear palsy patients reported to have axial dystonia in extension.[3] Patients with tardive syndrome, Wilson’s disease, neurodegeneration with brain iron accumulation, and some other genetic form of dystonia may have prominent truncal involvement. A subset of patients presents with isolated idiopathic truncal dystonia.

Research paper thumbnail of Teaching Video NeuroImage: Pendular Vertical Oscillations in a Young Adult With a Pontine Hemorrhage

Research paper thumbnail of Is peripheral alpha synuclein a marker for gait velocity in Parkinson’s disease?

Research paper thumbnail of Genome‐Wide Polygenic Score Predicts Large Number of High Risk Individuals in Monogenic Undiagnosed Young Onset Parkinson's Disease Patients from India

Advanced Biology

Parkinson's disease (PD) is a genetically heterogeneous neurodegenerative disease with poorly... more Parkinson's disease (PD) is a genetically heterogeneous neurodegenerative disease with poorly defined environmental influences. Genomic studies of PD patients have identified disease‐relevant monogenic genes, rare variants of significance, and polygenic risk‐associated variants. In this study, whole genome sequencing data from 90 young onset Parkinson's disease (YOPD) individuals are analyzed for both monogenic and polygenic risk. The genetic variant analysis identifies pathogenic/likely pathogenic variants in eight of the 90 individuals (8.8%). It includes large homozygous coding exon deletions in PRKN and SNV/InDels in VPS13C, PLA2G6, PINK1, SYNJ1, and GCH1. Eleven rare heterozygous GBA coding variants are also identified in 13 (14.4%) individuals. In 34 (56.6%) individuals, one or more variants of uncertain significance (VUS) in PD/PD‐relevant genes are observed. Though YOPD patients with a prioritized pathogenic variant show a low polygenic risk score (PRS), patients wit...

Research paper thumbnail of Short-Latency Afferent Inhibition Correlates with Stage of Disease in Parkinson’s Patients

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques

ABSTRACT:Background:Sensory-motor decoupling at the cortical level involving cholinergic circuitr... more ABSTRACT:Background:Sensory-motor decoupling at the cortical level involving cholinergic circuitry has also been reported in Parkinson’s Disease (PD). Short-latency afferent inhibition (SAI) is a transcranial magnetic stimulation (TMS) paradigm that has been used previously to probe cortical cholinergic circuits in well-characterised subgroups of patients with PD. In the current study, we compared SAI in a cohort of PD patients at various stages of disease and explored correlations between SAI and various clinical measures of disease severity.Methods:The modified Hoehn and Yahr (H&Y) scale was used to stage disease in 22 patients with PD. Motor and cognitive function were assessed using the MDS-UPDRS (Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale) part III and MoCA (Montreal Cognitive Assessment) score, respectively. Objective gait assessment was performed using an electronic walkway (GAITRite®). SAI was measured as the average percenta...

Research paper thumbnail of Clinical Study of 668 Indian Subjects with Juvenile, Young, and Early Onset Parkinson’s Disease

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 2021

ABSTRACT:Objective:To determine the demographic pattern of juvenile-onset parkinsonism (JP, <2... more ABSTRACT:Objective:To determine the demographic pattern of juvenile-onset parkinsonism (JP, <20 years), young-onset (YOPD, 20–40 years), and early onset (EOPD, 40–50 years) Parkinson’s disease (PD) in India.Materials and Methods:We conducted a 2-year, pan-India, multicenter collaborative study to analyze clinical patterns of JP, YOPD, and EOPD. All patients under follow-up of movement disorders specialists and meeting United Kingdom (UK) Brain Bank criteria for PD were included.Results:A total of 668 subjects (M:F 455:213) were recruited with a mean age at onset of 38.7 ± 8.1 years. The mean duration of symptoms at the time of study was 8 ± 6 years. Fifteen percent had a family history of PD and 13% had consanguinity. JP had the highest consanguinity rate (53%). YOPD and JP cases had a higher prevalence of consanguinity, dystonia, and gait and balance issues compared to those with EOPD. In relation to nonmotor symptoms, panic attacks and depression were more common in YOPD and sl...

Research paper thumbnail of Effect of mask on doctor–Patient relationship during COVID-19: Indian perspective

Annals of Indian Academy of Neurology, 2021

Research paper thumbnail of Efficacy and Safety of Ticagrelor and Aspirin in Patients With Moderate Ischemic Stroke

JAMA Neurology, 2021

Prior trials of dual antiplatelet therapy excluded patients with moderate ischemic stroke. These ... more Prior trials of dual antiplatelet therapy excluded patients with moderate ischemic stroke. These patients were included in the Acute Stroke or Transient Ischaemic Attack Treated With Ticagrelor and ASA for Prevention of Stroke and Death (THALES) trial, but results have not been reported separately, raising concerns about safety and efficacy in this subgroup. OBJECTIVE To evaluate the efficacy and safety of ticagrelor plus aspirin in patients with moderate ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score of 4 to 5). DESIGN, SETTING, AND PARTICIPANTS The THALES trial was a randomized trial conducted at 414 hospitals in 28 countries in January 2018 and December 2019. This exploratory analysis compared patients with moderate stroke (baseline NIHSS score of 4 to 5) with patients with less severe stroke (NIHSS score of 0 to 3). A total of 9983 patients with stroke were included in the present analysis, after excluding 2 patients with NIHSS scores greater than 5 and 1031 patients with transient ischemic attack. Data were analyzed from March to April 2021. INTERVENTIONS Ticagrelor (180-mg loading dose on day 1 followed by 90 mg twice daily on days 2 to 30) or placebo within 24 hours after symptom onset. All patients received aspirin, 300 to 325 mg, on day 1 followed by aspirin, 75 to 100 mg, daily on days 2 to 30. Patients were observed for 30 additional days. MAIN OUTCOMES AND MEASURES The primary outcome was time to stroke or death within 30 days. The primary safety outcome was time to severe bleeding. RESULTS In total, 3312 patients presented with moderate stroke and 6671 presented with less severe stroke. Of those in the moderate stroke group, 1293 (39.0%) were female, and the mean (SD) age was 64.5 (10.8) years; of those in the less severe stroke group, 2518 (37.7%) were female, and the mean (SD) age was 64.8 (11.2) years. The observed primary outcome event rate in patients with moderate stroke was 7.6% (129 of 1671) for those in the ticagrelor group and 9.1% (150 of 1641) for those in the placebo group (hazard ratio, 0.84; 95% CI, 0.66-1.06); the primary outcome event rate in patients with less severe stroke was 4.7% (158 of 3359) for those in the ticagrelor group and 5.7% (190 of 3312) for those in the placebo group (hazard ratio, 0.82; 95% CI, 0.66-1.01) (P for interaction = .88). Severe bleeding occurred in 8 patients (0.5%) in the ticagrelor group and in 4 patients (0.2%) in the placebo group in those with moderate stroke compared with 16 patients (0.5%) and 3 patients (0.1%), respectively, with less severe stroke (P for interaction = .26). CONCLUSIONS AND RELEVANCE In this study, patients with a moderate ischemic stroke had consistent benefit from ticagrelor plus aspirin vs aspirin alone compared with patients with less severe ischemic stroke, with no further increase in the risk of intracranial bleeding or other severe bleeding events. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03354429

Research paper thumbnail of Dance movement therapy in rehabilitation of Parkinson's disease – A feasibility study

Journal of Bodywork and Movement Therapies, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of A longitudinal quantitative analysis of gait in patients with SCA-12

Clinical Parkinsonism & Related Disorders, 2021

Spinocerebellar ataxia type 12 (SCA 12) is characterized by late onset tremor, ataxia and pyramid... more Spinocerebellar ataxia type 12 (SCA 12) is characterized by late onset tremor, ataxia and pyramidal signs. Parkinsonism and cognitive decline may appear with time. It is considered as slowly progressive but temporal evolution of symptoms has not been reported. Method: We report the evolution of symptoms in three SCA12 patients followed over a range of 5-6 years. We focused on the evolution of gait abnormality as it becomes the most disabling symptom as disease advances. Twodimensional gait parameters were studied using an electronic walkway at various time points to measure objective changes in gait. Result: All patients presented with tremor in the upper extremity at baseline which progressed non-uniformly over the years. Progression of gait variability measures of step length, stance time and step time were also observed. Conclusion: Gait characteristics such as variability may precede clinical gait abnormality and could serve as a sensitive marker for disease progression for better therapeutic intervention in disease management. Future studies with larger sample size should be undertaken to conclusively validate this observation.

Research paper thumbnail of Pattern Specific Dysgraphia—Beyond Letter Specificity

Movement Disorders Clinical Practice

Research paper thumbnail of Impact of COVID‐19 on Patient Care, Training, and Research in Movement Disorders in MDS‐AOS Region

Movement Disorders, 2021

The COVID-19 pandemic has caused disruptions in movement disorder clinical services and education... more The COVID-19 pandemic has caused disruptions in movement disorder clinical services and education. 1-5 The Movement Disorder Society-Asian and Oceanian Section (MDS-AOS) is a subsection of the MDS comprised of 41 countries and territories, with diverse socioeconomic backgrounds, health care systems, and varied exposure to prior pandemics. To determine the impact of the pandemic on clinical, training, and research activities of movement disorders, a structured questionnaire was developed with expert consensus during a conference call organized by the MDS-AOS. Fifteen months into the pandemic, that is, March 2021, members of the MDS-AOS were invited to participate in an online survey. The impact of the pandemic was graded from zero to five (zero: "no impact," five: "total disruption"), and responses were recorded over five time points. Seventy-four responses were received from 20 countries, with the majority (36%, n = 27) from India (Supplementary Material).

Research paper thumbnail of Impact of Home Confinement During the COVID‐19 Pandemic on Medication Use and Disease Activity in Spondyloarthritis Patients

Arthritis & Rheumatology, 2020

Impact of home confinement during the COVID-19 pandemic on medication use and disease activity in... more Impact of home confinement during the COVID-19 pandemic on medication use and disease activity in spondyloarthritis patients To the Editor: Home confinement, imposed as part of the social distancing measures in the fight against coronavirus disease 2019 (COVID-19), poses several problems for patients with spondyloarthritis (SpA), including the lack of physical activity (1), psychological factors, and confusion related to the prescriptions of nonsteroidal antiinflammatory drugs (NSAIDs) (2). We investigated the impact of confinement on medication use and disease activity in patients with SpA, using a questionnaire-based survey. Between April 10 and April 21, 2020, a questionnaire was administered to 1,656 members of a private social network of the Association Contre les Spondylarthrites (ACS). The questionnaire, created using Microsoft form software, included questions on age, SpA type, treatment with NSAIDs and biologic agents and their modifications, onset of flares, and infections including COVID-19. A written explanation of the study aim was provided with the questionnaire. The study protocol was approved by the National Ethics Commission (Clinicaltrials.gov identifier: NCT04355923). Overall, 609 (37%) of the 1,656 members of the ACS responded to the questionnaire. Patient characteristics and responses regarding treatment modification are shown in Table 1. From our survey, 382 of 609 subjects (63%) reported experiencing worsening disease during confinement, and 108 (28%) experienced considerable deterioration. Worsening of symptoms was significantly associated with treatment modification (P = 0.001). The number and severity of crises were greater during the confinement (of 512 patients with available information, 251 [49%] with severe flares during confinement versus 100 [20%] with severe flares before confinement [P < 0.001]). Further, 88 subjects (14%) reported experiencing an infectious disease during the confinement. The occurrence of infection was associated with treatment modification (P < 0.001), particularly when the infection was COVID-19 (P < 0.001). The frequency of COVID-19 infection in patients treated with biologic disease-modifying antirheumatic drug (DMARDs) or NSAIDs was not higher than that in subjects without such treatment (P = 0.6 and P = 0.4, respectively). The COVID-19 pandemic and the resulting confinement had significant consequences in this SpA population, with 47% of patients having changed their treatment. The majority of treatment changes were observed in patients who had been regularly

Research paper thumbnail of Validity, Reliability, and Insights from Applying the McGill Quality of Life Questionnaire to People Living with Parkinson's Disease (MQoL-PD)

Journal of palliative care, 2015

Existing quality-of-life instruments for Parkinson's disease (PD) may not fully assess qualit... more Existing quality-of-life instruments for Parkinson's disease (PD) may not fully assess quality of life (QoL) for people with PD in a holistic and multidimensional manner. This study examines the subscale structure, validity, and internal-consistency reliability of the McGill Quality of Life (MQoL) Questionnaire in a sample of people with PD. This cross-sectional study evaluates the MQoL-PD by using Cronbach's alpha and principal components analysis. A total of 81 consenting people with PD from a tertiary care outpatient clinic were studied. Scores were tabulated for the motor Unified Parkinson's Disease Rating Scale (mUPDRS), the Short Form Health Survey (SF-36), the Parkinson's Disease Questionnaire (PDQ-39), the MQoL Single-Item Scale (MQoL-SIS), and the MQoL Questionnaire (MQoL). Cronbach's alpha for the MQoL-PD was: physical symptoms, 0.83; psychological symptoms, 0.59; and existential/support symptoms, 0.76. Important contributors to QoL in PD include mobili...

Research paper thumbnail of Gait analysis in Parkinson’s disease assessing the effect of levodopa using a validated electronic walkway

Parkinsonism & Related Disorders, 2016

Research paper thumbnail of Ticagrelor Added to Aspirin in Acute Ischemic Stroke or Transient Ischemic Attack in Prevention of Disabling Stroke

JAMA Neurology, 2021

IMPORTANCE Reduction of subsequent disabling stroke is the main goal of preventive treatment in t... more IMPORTANCE Reduction of subsequent disabling stroke is the main goal of preventive treatment in the acute setting after transient ischemic attack (TIA) or minor ischemic stroke. OBJECTIVE To evaluate the superiority of ticagrelor added to aspirin in preventing disabling stroke and to understand the factors associated with recurrent disabling stroke. DESIGN, SETTING, AND PARTICIPANTS The Acute Stroke or Transient Ischemic Attack Treated With Ticagrelor and Aspirin for Prevention of Stroke and Death (THALES) was a randomized clinical trial conducted between January 22, 2018, and December 13, 2019, with a 30-day follow-up, at 414 hospitals in 28 countries. The trial included 11 016 patients with a noncardioembolic, nonsevere ischemic stroke or high-risk TIA, including 10 803 with modified Rankin Scale score (mRS) recorded at 30 days. INTERVENTIONS Ticagrelor (180-mg loading dose on day 1 followed by 90 mg twice daily for days 2-30) or placebo within 24 hours of symptom onset. All patients received aspirin, 300 to 325 mg on day 1 followed by 75 to 100 mg daily for days 2 to 30. MAIN OUTCOMES AND MEASURES Time to the occurrence of disabling stroke (progression of index event or new stroke) or death within 30 days, as measured by mRS at day 30. Disabling stroke was defined by mRS greater than 1. RESULTS Among participants with 30-day mRS greater than 1, mean age was 68.1 years, 1098 were female (42.6%), and 2670 had an ischemic stroke (95.8%) as a qualifying event. Among 11 016 patients, a primary end point with mRS greater than 1 at 30 days occurred in 221 of 5511 patients (4.0%) randomized to ticagrelor and in 260 of 5478 patients (4.7%) randomized to placebo (hazard ratio [HR], 0.83; 95% CI, 0.69-0.99, P = .04). A primary end point with mRS 0 or 1 at 30 days occurred in 70 of 5511 patients (1.3%) and 87 of 5478 patients (1.6%) (HR, 0.79; 95% CI, 0.57-1.08; P = .14). The ordinal analysis of mRS in patients with recurrent stroke showed a shift of the disability burden following a recurrent ischemic stroke in favor of ticagrelor (odds ratio, 0.77; 95% CI, 0.65-0.91; P = .002). Factors associated with disability were baseline National Institutes of Health Stroke Scale score 4 to 5, ipsilateral stenosis of at least 30%, Asian race/ethnicity, older age, and higher systolic blood pressure, while treatment with ticagrelor was associated with less disability. CONCLUSIONS AND RELEVANCE In patients with TIA and minor ischemic stroke, ticagrelor added to aspirin was superior to aspirin alone in preventing disabling stroke or death at 30 days and reduced the total burden of disability owing to ischemic stroke recurrence. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03354429

Research paper thumbnail of Asymmetry of Tremor in Spinocerebellar Ataxia 12‐ Exception or Rule?

Movement Disorders Clinical Practice, 2021

Research paper thumbnail of Supppl_doc – Supplemental material for A Novel Wearable Device for Motor Recovery of Hand Function in Chronic Stroke Survivors

Supplemental material, Supppl_doc for A Novel Wearable Device for Motor Recovery of Hand Function... more Supplemental material, Supppl_doc for A Novel Wearable Device for Motor Recovery of Hand Function in Chronic Stroke Survivors by Supriyo Choudhury, Ravi Singh, A. Shobhana, Dwaipayan Sen, Sidharth Shankar Anand, Shantanu Shubham, Suparna Gangopadhyay, Mark R. Baker, Hrishikesh Kumar and Stuart N. Baker in Neurorehabilitation and Neural Repair

Research paper thumbnail of Neuroimaging Pearls from the MDS Congress Video Challenge. Part 1: Genetic Disorders

Movement Disorders Clinical Practice, 2022

We selected several "imaging pearls" presented during the Movement Disorder Society (MDS) Video C... more We selected several "imaging pearls" presented during the Movement Disorder Society (MDS) Video Challenge for this review. While the event, as implicated by its name, was video-centered, we would like to emphasize the important role of imaging in making the correct diagnosis. We divided this anthology into two parts: genetic and acquired disorders. Genetic cases described herein were organized by the inheritance pattern and the focus was put on the imaging findings and differential diagnoses. Despite the overlapping phenotypes, certain described disorders have pathognomonic MRI brain findings that would provide either the "spot" diagnosis or result in further investigations leading to the diagnosis. Despite this, the diagnosis is often challenging with a broad differential diagnosis, and hallmark findings may be present for only a limited time.