Publications (26)37.12 Total impact
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Article: Validity of the Berlin Questionnaire in identifying obstructive sleep apnea syndrome when administered to the informants of stroke patients.
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ABSTRACT: Given the high prevalence of sleep-disordered breathing (SDB) in stroke and its importance as a vascular risk factor, a clinical instrument to assess its incidence would be useful. Acute stroke patients (n=121) were stratified into high- and low-risk groups for SDB using a modified Berlin Questionnaire (BQ) administered to the informants who were living with the patient. After a minimum of 4 weeks from stroke onset, patients who were fit underwent overnight polysomnography (PSG). On stratifying risk of obstructive sleep apnea (OSA) in these patients based on the BQ, 53% belonged to the high-risk group and 47% belonged to the low-risk group. There was poor correlation between the clinical questionnaire results and PSG findings, with sensitivity of 66.7%, specificity of 55.6%, a positive predictive value of 63.4%, and a negative predictive value of 58.8%.Journal of Clinical Neuroscience 03/2011; 18(3):340-3. · 1.25 Impact Factor -
Article: Characterization, thermodynamic parameters and in vivo antimalarial activity of inclusion complexes of artemether.
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ABSTRACT: The present study aimed to improve solubility, dissolution and ultimate bioavailability of poorly soluble artemether, an antimalarial drug, by encapsulating it in β-cyclodextrin (β-CD) and its methyl and hydroxylpropyl derivatives. The effect of these complexes was confirmed by in vivo studies. Phase solubility studies indicated 1:1 stoichiometry and were supported by mass spectrometry and proton nuclear magnetic resonance ((1)H-NMR) spectroscopy. True inclusion of artemether into the cyclodextrin cavity was observed in lyophilized complexes by differential scanning calorimetry (DSC), powder X-ray diffraction (PXRD) and Fourier transform infrared spectroscopy (FT-IR) studies. The mode of inclusion was supported by two-dimensional (2D) NMR. Solution calorimetry was used to confirm 1:1 stiochiometry by determining the enthalpy of interaction between the drug and cyclodextrins. The stability constant (K) of inclusion and other thermodynamic parameters such as enthalpy (ΔH) as well as entropy (ΔS) of binding accompanying the encapsulation were determined. The calculated value of K indicated that M-β-CD has maximum complexing efficiency. Dissolution studies indicated that the highest release rate was observed for lyophilized complexes. In vivo studies of lyophilized complexes of M-β-CD showed a 3-fold increase in antimalarial activity compared to artemether and resulted in 100% eradication of parasite. However, 83% and 50% survival rates were achieved in 40 days using HP-β-CD and β-CD complexes respectively. The study concludes that encapsulation of artemether by cyclodextrins is a good alternative to enhance the bioavailability of the drug.Drug discoveries & therapeutics. 06/2010; 4(3):190-201. -
Article: Clinical spectrum of Hallervorden-Spatz syndrome in India.
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ABSTRACT: Hallervorden-Spatz syndrome is a rare autosomal recessive disorder that involves progressive extrapyramidal manifestations. Classical and atypical clinical presentations are known. Clinical details of patients admitted to the neurology ward or attending the movement disorder clinic of the All India Institute of Medical Sciences between January 2001 and July 2007 were reviewed. Sixteen patients (9 males and 7 females) were included in the study (median age 14 years; range 6-25). The most common clinical presentation was limb or cranial onset progressive dystonia. The patients with early onset had more frequent truncal and axial dystonia, including retrocollis, oromandibular-facial dystonia and chorea, dysarthria, pyramidal signs, gait disturbance, cognitive impairment, delay in milestones, retinitis pigmentosa, optic atrophy, oculomotor abnormalities, positive family history and acanthocytosis. Although rare, cerebellar ataxia, behavioural abnormalities, parkinsonism and apraxia of eyelid opening were exclusively seen in late onset patients. The present study highlights the heterogeneity of this disease entity and also describes certain unusual clinical features.Journal of Clinical Neuroscience 01/2009; 16(2):253-8. · 1.25 Impact Factor -
Article: Functional mapping in PD and PSP for sustained phonation and phoneme tasks.
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ABSTRACT: To elucidate the central basis of articulatory speech disorders in Parkinsonian syndromes using functional magnetic resonance imaging (fMRI). Twenty-two patients with Parkinson's disease (PD) and 18 with progressive supranuclear palsy (PSP) were clinically evaluated for speech dysfunction. Functional magnetic resonance imaging (fMRI) was carried out in these patients using sustained phonation and phoneme tasks. Individual and group analysis using SPM2 was done for eight patients with PD, 7 with PSP and 6 healthy controls. Tertiary Medical Teaching Institute. For sustained phonation paradigm, superior temporal gyrus area was activated in PD patients, and occipital cortex in PSP subjects in comparison to controls. For phoneme paradigm, the patients with PD recruit lingual gyrus obviating the need for more efforts for the task. Also wider areas as well as more clusters were activated in PD patients compared to controls. Lingual gyrus was found to be strongly activated in PSP patients. Reduced activation of the primary areas with recruitment of remote areas was another prominent finding in PSP. Due to excessive motion (>1.5 mm, >1 degrees ) in all the MSA patients, they could not be considered for analysis. The failure of the executive fronto-striatal network would lead to increased activation of other areas in PD, but in PSP, there is a widespread cortical dysfunction.Journal of the Neurological Sciences 10/2008; 273(1-2):51-6. · 2.35 Impact Factor -
Article: Clinical speech impairment in Parkinson′s disease , progressive supranuclear palsy, and multiple system atrophy
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ABSTRACT: Context: Speech abnormalities are common to the three Parkinsonian syndromes, namely Parkinson′s disease (PD), progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), the nature and severity of which is of clinical interest and diagnostic value. Aim: To evaluate the clinical pattern of speech impairment in patients with PD, PSP and MSA and to identify significant differences on quantitative speech parameters when compared to controls. Design and Setting: Cross-sectional study conducted in a tertiary medical teaching institute. Materials and Methods: Twenty-two patients with PD, 18 patients with PSP and 20 patients with MSA and 10 age-matched healthy controls were recruited over a period of 1.5 years. The patients were clinically evaluated for the presence and characteristics of dysarthria. This was followed by quantitative assessment of three parameters: maximum phonation time (MPT), semantic fluency and reading speed. The outcome measures were compared between the patient groups and with controls. Results: Patients with PD had hypophonic monotonous speech with occasional rushes of speech while patients with MSA and PSP had mixed dysarthria with ataxic and spastic elements respectively. All quantitative parameters were affected when compared to controls ( P values < 0.001, 0.012 and 0.008 respectively). Maximum phonation time was significantly less in PSP when compared to MSA and PD ( P =0.015). Reading speed also showed a similar trend which was not statistically significant. Semantic fluency was comparable in all three groups. Conclusion: Dysarthria in PD, PSP and MSA have many overlapping but certain distinctive features as well which could serve as a diagnostic clue. Patients with PSP had profound speech impairment probably indicative of the more severe frontostriatial pathology.Neurology India. 01/2008; -
Article: Authors′ reply
Neurology India. 01/2007; -
Article: Hyperacute thrombolysis with IV rtPA of acute ischemic stroke: Efficacy and safety profile of 54 patients at a tertiary referral center in a developing country
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ABSTRACT: Background: Given the constraints of resources, thrombolysis for acute ischemic stroke (AIS) is under evaluation in developing countries. Prothrombin time (PT), platelet count and activated partial thromboplastin time (aPTT) may not be feasible within the time window. Aim: To evaluate the safety and efficacy of thrombolysis in selected patients without the coagulation profile. Design: Open, nonrandomized, observational study. Materials and Methods: Fifty-four stroke patients were classified using TOAST criteria (large artery atherosclerotic = 13; cardioembolic = 12; small vessel occlusion = 22; other determined etiology =three; undetermined etiology = four). The mean time to reach emergency was 2.4h (1.15-3.4), the mean door to CT, 24 min (10-47) and the door to recombinant tissue plasminogen activator (r-tPA) injection, 26.8 min (25-67). The NIHSS scores ranged from 11 to 22 (mean = 15.5 ± 2.7). Patients with history of liver or renal disease or those on anticoagulants were excluded. The PT, aPTT and platelet count were not done. Recombinant tissue plasminogen activator was administered at a dosage of 0.9 mg/Kg. Results: Thirty-five patients (65%) significantly improved on NIHSS at 48h (³4 points) (mean change = 10; range= 4-17). At one month, 43 (79%) improved on Barthel Index (mean change = 45%). One each developed small frontal lobe hemorrhage and recurrent stroke; one died of aspiration; and eight showed no improvement. Conclusions: Hyperacute thrombolysis was found useful and safe in selected patients with AIS even without the coagulation studies.Neurology India. 01/2007; -
Article: The enigmatic origin of subfrontal schwannomas: report of a case without hyposmia.
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ABSTRACT: Subfrontal schwannomas are rare intracranial tumors. Most of them are associated with hyposmia/anosmia. The source of origin of these tumors is still incompletely understood. We report a 23-year-old male who presented with recurrent focal motor seizures, but had no hyposmia. The tumor was completely removed by a subfrontal approach. Relevant literature has been reviewed.Acta Neurochirurgica 07/2006; 148(6):671-2; discussion 672. · 1.52 Impact Factor -
Article: Hypoglossal nerve paralysis caused by high cervical epidural abscess.
Neurology 03/2006; 66(4):522. · 8.31 Impact Factor -
Article: Quantitative thermal sensory testing in patients with monomelic amyotrophy.
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ABSTRACT: Quantitative thermal sensory testing (QST) is a non-invasive method to assess somatic small fibre dysfunction, which is not evaluated with routine nerve conduction studies (NCS). Monomelic amyotrophy (MMA), is a pure motor disorder with no sensory abnormalities on routine NCS, and has not been evaluated using QST. Present study aimed to evaluate somatic small fibre involvement in MMA patients. Forty patients with MMA with no sensory abnormalities or routine NCS were evaluated using QST for thresholds of cold sensation (CS), warm sensation (WS), cold pain (CP) and warm pain (WP), using method of limits. These were compared with 40 age-matched controls. No abnormalities in thresholds for CS, WS, CP and WP were found in MMA group as compared to controls. QST thus failed to demonstrate any abnormality. Hence we conclude that MMA is a pure motor disorder, with no involvement of somatic small sensory fibres (A delta and C).Electromyography and clinical neurophysiology 01/2006; 45(7-8):387-91. -
Article: Unidirectional whole body turning: a new lateralising sign in complex partial seizures.
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ABSTRACT: The lateralising significance of unidirectional whole body turning in patients with complex partial seizures (CPS) arising from the temporal lobe was evaluated. A total of 330 patients undergoing long term video-EEG study were included. "Unidirectional whole body turning" was defined as rotation of the trunk, head, and limbs by >90 degrees and lasting >10 s. EEG correlates, MRI, and SPECT findings were compared and outcome after surgery was noted for patients with follow up data for >1 year. Unidirectional whole body turning was observed in 13 patients with a mean age of 18+/-8 years. Concordance of the side of whole body turning with the EEG focus and MRI findings was observed in 11 of the 13 patients (84.7%) and in 26 of 28 seizures (92.8%). The six patients who underwent temporal lobectomy or resection of lesion, opposite to the direction of body turning, had good seizure outcome. Unidirectional whole body turning is a new lateralising sign in temporal lobe CPS with good predictive value for epileptogenic focus contralateral to the direction of turning.Journal of Neurology Neurosurgery & Psychiatry 12/2005; 76(12):1726-9. · 4.76 Impact Factor -
Article: "Hot cross bun" sign in two patients with multiple system atrophy-cerebellar.
Neurology 02/2005; 64(1):128. · 8.31 Impact Factor -
Article: Threshold intensity and central motor conduction time in patients with monomelic amyotrophy: a transcranial magnetic stimulation evaluation.
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ABSTRACT: To determine the Cortical threshold intensity (TI) and central motor conduction time (CMCT) in patients with monomelic amyotrophy (MMA). TI and CMCT were evaluated by means of transcranial magnetic stimulation in 18 patients of MMA and 12 healthy controls at the clinical neurophysiology laboratory, department of neurology, All India Institute of Medical Sciences, New Delhi. The mean age of patients was 23.6 (SD 6. 7) years and of controls was 24.3 (SD 3.2) years (p > 0. 05). The mean TI in patients was 60.83% (SD 11.28) on ipsilateral and 60% (11.5%) on contralateral cortex stimulation. In controls, the mean TI was 66.67% (SD 11.5) on one side and 65% (11.87%) on contralateral cortex stimulation. There was no significant difference in the TI between these two groups (p > 0.05). The mean CMCT in patients was 8.3 (SD 1. 7) ms on ipsilateral and 9.4 (SD 1.6) ms on contralateral cortex stimulation (p > 0.05). In controls CMCT was 8.3 (SD 1.8) ms on one side and 8.6 (SD 1.4) ms on contralateral cortex stimulation. Upper limit of normal CMCT was 12.7 ms. As compared to controls there was no significant abnormality in TI and CMCT was normal in all except two patients where it was marginally prolonged. This could be because of excessive loss of anterior horn cells.Electromyography and clinical neurophysiology 09/2004; 44(6):357-60. -
Article: A study of nonepileptic seizures in an Indian population.
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ABSTRACT: The goal of this study was to evaluate the background and the clinical profile of nonepileptic seizures (NESs) confirmed by short-term video encephalography (ST-VEEG) recording in an Indian population. Seventy-one patients with NESs were enrolled. A complete history was taken and the recorded event was reviewed to define the ictal events. Patients were divided into two groups, Group 1 with a paucity of movements and Group 2 with an excess of movement, and results were analyzed. The mean age was 22.9 (9.6); there were 15 males (21.1%) and 56 females (78.9%). Twenty-four patients (33.8%) were receiving antiepileptic drugs. The majority of the patients (42, 59.1%) were students. All patients were amnesic for the event and were unresponsive during the event. The other characteristics were similar events in 98.6%, hyperventilation in 58 (81.7%). Forty-two patients (59.2%) were in Group 1 and 29 patients (40.8%) were in Group 2. NES is a disease of the young and can affect the student or professional. A wrong diagnosis can result in inappropriate treatment. Awareness of this entity is critical to ensuring prompt diagnosis and early intervention.Epilepsy & Behavior 11/2003; 4(5):496-9. · 2.34 Impact Factor -
Article: Cortical silent period in essential tremor.
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ABSTRACT: Pathophysiology of essential tremor (ET) is controversial, current evidence indicating its genesis through a central oscillator and modulation by a peripheral component. Since transcranial magnetic stimulation induced silent period (SP) has been attributed mainly to intracortical inhibitory mechanisms, it has been found useful in assessing central motor disturbances. To assess if the cortically induced SP was different in ET patients as compared to age matched healthy controls. Twenty-four patients of ET (mean age 45.4 +/- 14.9 years) diagnosed according to criteria of Louis et al (1998) and an equal number of healthy controls (mean age 36.2 +/- 15.7 years) were recruited in the study. Cortically induced (magnetic) SP were recorded according to the standard methods described. Student's "t" test and Wilcoxon sign rank test were used for statistical analysis. The mean +/- SD cortical SP in ET patients (180.75 +/- 57.11 msec) in ET patients and in controls (163.83 +/- 35.65 msec) were statistically similar (p = 0.22). Our study shows that there is no significant difference in mean cortical SPs in patients with ET as compared to controls.Electromyography and clinical neurophysiology 10/2003; 43(6):329-33. -
Article: Peripheral silent periods in essential tremor.
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ABSTRACT: Pathophysiology of essential tremor (ET) is controversial. In the present study, peripherally induced silent period (SP) in ET patients is studied. To study if the peripherally induced SP was different in ET patients as compared to age matched healthy controls. 24 patients of ET diagnosed according to diagnostic criteria of Louis et al. [Neurology 50 (1998) 1351] (mean age 45.37+/-14.86 years) and an equal number of healthy controls (mean age 36.21+/-15.72 years) were recruited for the study. Peripherally induced SP was recorded according to the methods already described. Student's t-test and Wilcoxon sign rank test were used for statistical analysis. The peripheral SP was 50.29+/-50.15 and 93.04+/-35.93 ms (p=0.0014) in ET patients and controls respectively. Our study shows that peripheral silent period is shorter in patients of ET as compared to normal individuals.Journal of the Neurological Sciences 08/2002; 199(1-2):55-8. · 2.35 Impact Factor -
Article: The lateralizing significance of version of head and dystonic limb posturing in epileptic seizures.
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ABSTRACT: Several clinical signs have been described for lateralization and localization of seizure focus in complex partial seizures; however, the specificity of each of these has been widely debated upon. The present study was done to evaluate 'dystonic unilateral limb posturing' and 'versive head movements' for lateralization and localization of epileptic foci in patients with intractable partial complex seizures, being investigated with long term Video-EEG monitoring. Fifteen patients with 46 seizures, studied with long term Video EEG, had either one or both of these signs. The video recordings of the clinical behaviour were noted and later compared with the corresponding EEG. Unilateral dystonic limb posturing and versive head movements had good lateralising value in complex partial seizures, suggestive of temporal lobe origin, contralateral to the seizure focus, with a specificity of 87.5% and 86% respectively. In addition, turning of the whole body to one side was associated with a contralateral seizure focus in 100% cases. Appendicular automatisms were found to be of no lateralising significance, as they occurred on either side with equal frequency. These motor phenomena should, therefore, be enquired about in detail, during history taking for lateralization or localization of seizure focus.Neurology India 04/2002; 50(1):33-6. · 0.96 Impact Factor -
Article: The lateralizing significance of version of head and dystonic limb posturing in epileptic seizures.
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ABSTRACT: Several clinical signs have been described for lateralization and localization of seizure focus in complex partial seizures; however, the specificity of each of these has been widely debated upon. The present study was done to evaluate ′dystonic unilateral limb posturing′ and ′versive head movements′ for lateralization and localization of epileptic foci in patients with intractable partial complex seizures, being investigated with long term Video-EEG monitoring. Fifteen patients with 46 seizures, studied with long term Video EEG, had either one or both of these signs. The video recordings of the clinical behaviour were noted and later compared with the corresponding EEG. Unilateral dystonic limb posturing and versive head movements had good lateralising value in complex partial seizures, suggestive of temporal lobe origin, contralateral to the seizure focus, with a specificity of 87.5% and 86% respectively. In addition, turning of the whole body to one side was associated with a contralateral seizure focus in 100% cases. Appendicular automatisms were found to be of no lateralising significance, as they occurred on either side with equal frequency. These motor phenomena should, therefore, be enquired about in detail, during history taking for lateralization or localization of seizure focus.Neurology India. 01/2002; -
Article: Isolated angiitis of the central nervous system: report of a patient with an unusually prolonged course.
European Neurology 02/2001; 46(3):162-3. · 1.81 Impact Factor -
Article: Clinical speech impairment in Parkinson's disease, progressive supranuclear palsy, and multiple system atrophy.
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ABSTRACT: Speech abnormalities are common to the three Parkinsonian syndromes, namely Parkinson's disease (PD), progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), the nature and severity of which is of clinical interest and diagnostic value. To evaluate the clinical pattern of speech impairment in patients with PD, PSP and MSA and to identify significant differences on quantitative speech parameters when compared to controls. Cross-sectional study conducted in a tertiary medical teaching institute. Twenty-two patients with PD, 18 patients with PSP and 20 patients with MSA and 10 age-matched healthy controls were recruited over a period of 1.5 years. The patients were clinically evaluated for the presence and characteristics of dysarthria. This was followed by quantitative assessment of three parameters: maximum phonation time (MPT), semantic fluency and reading speed. The outcome measures were compared between the patient groups and with controls. Patients with PD had hypophonic monotonous speech with occasional rushes of speech while patients with MSA and PSP had mixed dysarthria with ataxic and spastic elements respectively. All quantitative parameters were affected when compared to controls (P values<0.001, 0.012 and 0.008 respectively). Maximum phonation time was significantly less in PSP when compared to MSA and PD (P=0.015). Reading speed also showed a similar trend which was not statistically significant. Semantic fluency was comparable in all three groups. Dysarthria in PD, PSP and MSA have many overlapping but certain distinctive features as well which could serve as a diagnostic clue. Patients with PSP had profound speech impairment probably indicative of the more severe frontostriatial pathology.Neurology India 56(2):122-6. · 0.96 Impact Factor
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Institutions
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2001–2011
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All India Institute of Medical Sciences
- Department of Neurology
New Delhi, NCT, India
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