Reeja Rajan - Academia.edu (original) (raw)

Papers by Reeja Rajan

International Journal of Innovative Research in Medical Science, 2021

Objectives: This study was conducted to obtain data on the cognitive effects of lacosamide in Ind... more Objectives: This study was conducted to obtain data on the cognitive effects of lacosamide in Indian population. Methodology: An open labelled prospective observational study in 22 patients who suffered from focal epilepsy. Results: All the pre and post lacosamide cognition scores showed statistically significant positive correlation in this study. Average initial seizure frequency per month was 3.56 (SD 2.58) and median frequency 2.5 seizures per month. Range being 1-8 per month. At the final follow-up at 6months, 87.5% of the study subjects had no seizures. In the remaining12.5% of patients, reduction in seizure frequency was observed. The difference in frequency is statistically significant (Wilcoxon Signed Ranks TestP <0.001). Conclusion: Excellent seizure control is observed in patients with refractory focal epilepsy treated with lacosamide. Also, lacosamide has no serious adverse effects or drug interactions. In this study, it is observed that unlike many AEDs, lacosamide c...

Newer antiepileptic drugs (AEDs) offer favourable safety profiles than the previously used AEDs. ... more Newer antiepileptic drugs (AEDs) offer favourable safety profiles than the previously used AEDs. Despite the introduction of many AEDs, a large number of patients continue to suffer from uncontrolled partial-onset seizures which have considerable impact on a patient’s quality of life. Lacosamide (LCM) is a third generation AED approved for adjunctive use in partial-onset seizures. Patients with epilepsy frequently experience cognitive dysfunctions due to a variety of factors. Because AEDs are the major therapeutic modality for epilepsy, the adverse effects of AEDs on cognition are important. Objectives To assess the adverse effects of lacosamide on cognition among patients with localization related epilepsy to whom lacosamide is given as adjuvant therapy. METHODOLOGY An open labelled prospective observational study in 22 patients who suffered from localization related epilepsy. Results Average Initial seizure frequency per month was 3.56 (SD 2.58) and median frequency 2.5 seizures p...

Annals of Indian Academy of Neurology, 2019

IntRoductIon Parkinson's disease (PD) is one of the most common neurodegenerative diseases encoun... more IntRoductIon Parkinson's disease (PD) is one of the most common neurodegenerative diseases encountered in clinical practice. Increased awareness and access to quality health care have seen a greater number of patients on Levodopa treatment in India. The initial solace patients and treating doctors' experience due to the exquisite response to levodopa gives way to despair with the onset of disabling dyskinesias. Invariably, most PD patients go on to develop levodopa-induced dyskinesias (LID). [1] However, some patients develop early or severe disabling dyskinesias. The factors deciding which subset of PD patients go on to develop early or severe disabling dyskinesias are less clear. Dyskinesias can vary in type and severity. The management of LID also depends on the same. We undertook this study to analyze the clinical profile, disability, and predictors of LID. mateRIals and methods This was a cross-sectional observational study conducted in the Department of Neurology, Government Medical College, Thiruvananthapuram. Consecutive patients with PD (The UK PD Brain Bank Clinical Criteria), attending our movement disorder clinic, were included in the study after obtaining the Institutional Ethics Committee approval. Patients on levodopa treatment with a minimum follow-up of 6 months were included in the study. Patients on antipsychotics, those with alternative causes for dyskinesia, and who had premorbid dyskinesia were excluded from the study. The predictors of LID in patients with PD were studied and analyzed. We also examined the clinical profile and effect of LID on activities of daily living (ADL). After obtaining written informed consent, the patient's demographic details and clinical information including disease duration, duration of treatment with levodopa, the total dose of levodopa per day, and drugs currently used were noted. Video recordings of dyskinesias were analyzed for classification. [2] The modified Hoehn and Yahr stage, [3] Unified PD Rating Scale Part III, Unified Dyskinesia Rating Scale, [4] and PDY-26 item questionnaire were recorded. All patients were observed before and after administration of levodopa to assess onset, Background: Levodopa has a superior antiparkinsonian effect than dopamine agonists making it the standard of care for patients with Parkinson's disease (PD). During the initial stages, PD patients show a steady response to levodopa. Response fluctuations and levodopa-induced dyskinesias (LID) develop subsequently. The timing and onset of dyskinesias vary among individuals, and there are very few studies identifying the predictors of dyskinesia in India. Aims: We aimed to study the clinical profile, disability, and predictors of LID in a patient with PD. Materials and Methods: This was a cross-sectional observational study of consecutive patients with PD attending our movement disorder clinic. Patients on levodopa treatment with a minimum follow-up of 6 months were included in the study. All patients were observed before and after administration of levodopa to assess onset, duration of action, and timing of dyskinesias. Dyskinesias were video recorded and classified. Bivariate analysis was performed using Chi-square test or Fisher's exact test and multivariate analysis using binary logistic regression. Results: This study recruited 110 patients with PD on levodopa therapy. Thirty-one (28.1%) out of 110 had LID. Of these, 25 patients (80.6%) had on-time dyskinesia, 19 patients (61.3%) had off-time dystonia, and 13 patients (41.9%) had diphasic dyskinesia. Majority had only mild-to-moderate dyskinesia. Incapacitating dyskinesias were during off time, primarily affecting the foot. Age, disease duration, disease severity, duration of treatment, and total dose of levodopa were found to be predictors of LID. Multivariate regression analysis showed younger age and longer duration of levodopa treatment to be independent predictors for LID. Conclusions: LID is fairly common in PD though not severely disabling. Patients with younger age of onset, longer disease duration, and severe disease were more likely to get early LID. We observed the lower prevalence of LID when initiating at lower doses and slow titration of levodopa.

International Journal of Basic & Clinical Pharmacology, 2017

Background: Parkinson disease (PD) generally requires therapy for prolonged periods often with mu... more Background: Parkinson disease (PD) generally requires therapy for prolonged periods often with multiple drugs; drug-related adverse effects often add to the existing morbidity. Although, such ADRs are common, comprehensive information about their incidence, severity, and ultimate health effects are not available. The objective of the study was to analyze the pattern of occurrence of Adverse Drug Reactions (ADRs) in patients receiving anti-parkinson agents (APA) in a tertiary care hospital. We also aimed to assess the causality, severity and preventability of these ADRs.Methods: This prospective, observational study with 6 month follow up was conducted among consecutive PD patients receiving anti parkinson agents attending the Movement disorder clinic of Neurology department between April 1st 2011 and September 30th 2012. Tools used were ADR Reporting form of National Pharmacovigilance centre, WHO causality scale, Hartwig and Siegel scale to assess severity and Schumock and Thornton ...

International Journal of Innovative Research in Medical Science, 2021

Objectives: This study was conducted to obtain data on the cognitive effects of lacosamide in Ind... more Objectives: This study was conducted to obtain data on the cognitive effects of lacosamide in Indian population. Methodology: An open labelled prospective observational study in 22 patients who suffered from focal epilepsy. Results: All the pre and post lacosamide cognition scores showed statistically significant positive correlation in this study. Average initial seizure frequency per month was 3.56 (SD 2.58) and median frequency 2.5 seizures per month. Range being 1-8 per month. At the final follow-up at 6months, 87.5% of the study subjects had no seizures. In the remaining12.5% of patients, reduction in seizure frequency was observed. The difference in frequency is statistically significant (Wilcoxon Signed Ranks TestP <0.001). Conclusion: Excellent seizure control is observed in patients with refractory focal epilepsy treated with lacosamide. Also, lacosamide has no serious adverse effects or drug interactions. In this study, it is observed that unlike many AEDs, lacosamide c...

Newer antiepileptic drugs (AEDs) offer favourable safety profiles than the previously used AEDs. ... more Newer antiepileptic drugs (AEDs) offer favourable safety profiles than the previously used AEDs. Despite the introduction of many AEDs, a large number of patients continue to suffer from uncontrolled partial-onset seizures which have considerable impact on a patient’s quality of life. Lacosamide (LCM) is a third generation AED approved for adjunctive use in partial-onset seizures. Patients with epilepsy frequently experience cognitive dysfunctions due to a variety of factors. Because AEDs are the major therapeutic modality for epilepsy, the adverse effects of AEDs on cognition are important. Objectives To assess the adverse effects of lacosamide on cognition among patients with localization related epilepsy to whom lacosamide is given as adjuvant therapy. METHODOLOGY An open labelled prospective observational study in 22 patients who suffered from localization related epilepsy. Results Average Initial seizure frequency per month was 3.56 (SD 2.58) and median frequency 2.5 seizures p...

Annals of Indian Academy of Neurology, 2019

IntRoductIon Parkinson's disease (PD) is one of the most common neurodegenerative diseases encoun... more IntRoductIon Parkinson's disease (PD) is one of the most common neurodegenerative diseases encountered in clinical practice. Increased awareness and access to quality health care have seen a greater number of patients on Levodopa treatment in India. The initial solace patients and treating doctors' experience due to the exquisite response to levodopa gives way to despair with the onset of disabling dyskinesias. Invariably, most PD patients go on to develop levodopa-induced dyskinesias (LID). [1] However, some patients develop early or severe disabling dyskinesias. The factors deciding which subset of PD patients go on to develop early or severe disabling dyskinesias are less clear. Dyskinesias can vary in type and severity. The management of LID also depends on the same. We undertook this study to analyze the clinical profile, disability, and predictors of LID. mateRIals and methods This was a cross-sectional observational study conducted in the Department of Neurology, Government Medical College, Thiruvananthapuram. Consecutive patients with PD (The UK PD Brain Bank Clinical Criteria), attending our movement disorder clinic, were included in the study after obtaining the Institutional Ethics Committee approval. Patients on levodopa treatment with a minimum follow-up of 6 months were included in the study. Patients on antipsychotics, those with alternative causes for dyskinesia, and who had premorbid dyskinesia were excluded from the study. The predictors of LID in patients with PD were studied and analyzed. We also examined the clinical profile and effect of LID on activities of daily living (ADL). After obtaining written informed consent, the patient's demographic details and clinical information including disease duration, duration of treatment with levodopa, the total dose of levodopa per day, and drugs currently used were noted. Video recordings of dyskinesias were analyzed for classification. [2] The modified Hoehn and Yahr stage, [3] Unified PD Rating Scale Part III, Unified Dyskinesia Rating Scale, [4] and PDY-26 item questionnaire were recorded. All patients were observed before and after administration of levodopa to assess onset, Background: Levodopa has a superior antiparkinsonian effect than dopamine agonists making it the standard of care for patients with Parkinson's disease (PD). During the initial stages, PD patients show a steady response to levodopa. Response fluctuations and levodopa-induced dyskinesias (LID) develop subsequently. The timing and onset of dyskinesias vary among individuals, and there are very few studies identifying the predictors of dyskinesia in India. Aims: We aimed to study the clinical profile, disability, and predictors of LID in a patient with PD. Materials and Methods: This was a cross-sectional observational study of consecutive patients with PD attending our movement disorder clinic. Patients on levodopa treatment with a minimum follow-up of 6 months were included in the study. All patients were observed before and after administration of levodopa to assess onset, duration of action, and timing of dyskinesias. Dyskinesias were video recorded and classified. Bivariate analysis was performed using Chi-square test or Fisher's exact test and multivariate analysis using binary logistic regression. Results: This study recruited 110 patients with PD on levodopa therapy. Thirty-one (28.1%) out of 110 had LID. Of these, 25 patients (80.6%) had on-time dyskinesia, 19 patients (61.3%) had off-time dystonia, and 13 patients (41.9%) had diphasic dyskinesia. Majority had only mild-to-moderate dyskinesia. Incapacitating dyskinesias were during off time, primarily affecting the foot. Age, disease duration, disease severity, duration of treatment, and total dose of levodopa were found to be predictors of LID. Multivariate regression analysis showed younger age and longer duration of levodopa treatment to be independent predictors for LID. Conclusions: LID is fairly common in PD though not severely disabling. Patients with younger age of onset, longer disease duration, and severe disease were more likely to get early LID. We observed the lower prevalence of LID when initiating at lower doses and slow titration of levodopa.

International Journal of Basic & Clinical Pharmacology, 2017

Background: Parkinson disease (PD) generally requires therapy for prolonged periods often with mu... more Background: Parkinson disease (PD) generally requires therapy for prolonged periods often with multiple drugs; drug-related adverse effects often add to the existing morbidity. Although, such ADRs are common, comprehensive information about their incidence, severity, and ultimate health effects are not available. The objective of the study was to analyze the pattern of occurrence of Adverse Drug Reactions (ADRs) in patients receiving anti-parkinson agents (APA) in a tertiary care hospital. We also aimed to assess the causality, severity and preventability of these ADRs.Methods: This prospective, observational study with 6 month follow up was conducted among consecutive PD patients receiving anti parkinson agents attending the Movement disorder clinic of Neurology department between April 1st 2011 and September 30th 2012. Tools used were ADR Reporting form of National Pharmacovigilance centre, WHO causality scale, Hartwig and Siegel scale to assess severity and Schumock and Thornton ...