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AIM: To study the impact of trajectory parameters on Microelectrode recording during Subthalamic nucleus deep brain stimulation surgery in PD patients. MATERIALS AND METHODS: This is a retrospective study. On the day of surgery MRI was taken with frame on which planning was done using stereocalc and navigation systems and final coordinates of X, Y, Z, mid sagittal angle, axial angles were obtained. During surgery Microelectrode recording (MER) was done and with bed side examination final lead placement decided. Impact of trajectory angles on MER was studied using appropriate statistical analysis. RESULTS: Among 40 patients studied, mean age of patients and duration of disease were 55.65years and 7.95 years. Mean UPDRS OFF and ON scores were 60.7 and 15.4 respectively and mean MOCA score was 26.6. Distribution of type of recording differs significantly across mid sagittal angles among <15° vs >15° (P <0.05). Group of <15° for midsagittal angle and >75o for axial angle had highest percentage (60%) showing no recording when compared to others. Significantly higher proportion of cases with higher duration of PD had higher incidence of no recording and vice-versa (P <0.05). CONCLUSION: The study found a correlation between approach angle and the quality of MER. Results showed that a midsagittal angle > 15o and an axial angle < 75o produced better MERs. Although not statistically significant, this could suggest approach angles may have a role to achieve good microelectrode recordings. Larger prospective studies may be helpful to understand this further. [ABSTRACT FROM AUTHOR]

Objective: Non-motor symptoms (NMS) play a vital role in managing Parkinson's disease (PD) and have become the leading cause of deterioration of quality of life with the progression of the disease. The aim of the present study was to investigate the prevalence of NMS in PD with disease duration. Materials and Methods: We selected 75 patients with PD prospectively and all patients were diagnosed according to the United Kingdom PD Brain Bank criteria. All patients were trichotomized based on disease duration (≤4 years, 5-8 years and ≥9 years). The NMS screening questionnaire comprising 30 items was completed by all patients. Results: Out of 75 patients, men constituted 82.6%, the mean age was 59.2±1.51 (range, 45-69) years. The overall prevalence of NMS was 100%. Among the patients with a disease duration of ≤4 years, 5-8 years, and ≥9 years, gastrointestinal symptoms were observed in 38%, 48%, and 86.2%; cardiovascular dysfunction in 47.6%, 44%, and 82.7%; urinary problems in 38%, 40%, and 72.4%; poor sexual performance in 42.8%, 40%, and 79.3%; sleep disturbance in 38%, 36%, and 75.8%; anxiety in 33.3%, 40%, and 79.3%; hallucinations in 33.3%, 36%, and 72.4%; and cognition problems in 38%, 32%, and 72.4%, respectively. Significantly higher prevalences of gastrointestinal symptoms (p=0.006), cardiovascular dysfunctions (p=0.007), urinary problems (p=0.03), poor sexual performance (p=0.007), sleep disturbances (p=0.007), anxiety (p=0.007), hallucinations (p=0.03), and cognitive problems (p=0.007) were noted in patients with ≥9 years disease duration. Conclusion: Our study established that 100% of patients with PD had at least one NMS and there was a higher prevalence of NMS among those with disease duration more than 9 years. [ABSTRACT FROM AUTHOR]

Immense gas hydrate reservoirs have been reported in the Krishna-Godavari Basin, India. They mostly constitute methane gas and could serve as an alternative energy source. For efficient exploitation of methane from hydrates, it is crucial to know the region’s stability conditions. The present study reports the stability and equilibrium conditions of methane hydrates, synthesized with seawater obtained from the Krishna-Godavari Basin. At Station MD161/02/GH, the water samples are collected at depths ranging from 500 to 1,500 m. The influence of salinity on methane hydrate formation and dissociation in the presence of seawater is established. The hydrate dissociation patterns in seawater and saline water (4 wt% NaCl) are similar and follow the phase equilibrium around 6 wt% NaCl. The identical dissociation behavior of the two systems ascertains seawater to have ~4 wt% salinity. The salinity concentration varies little with depth because the hydrate dissociation temperatures are the same for all the samples collected at the three depths. Using the Clausius-Clapeyron equation, dissociation enthalpies are calculated. The dissociation enthalpy in saline systems is about 6% higher. The hydrate growth kinetics is marginally faster in the saline system. [ABSTRACT FROM AUTHOR]

Over the past two decades, our understanding of Parkinson's disease (PD) has been gleaned from the discoveries made in familial and/or sporadic forms of PD in the Caucasian population. The transferability and the clinical utility of genetic discoveries to other ethnically diverse populations are unknown. The Indian population has been under-represented in PD research. The Genetic Architecture of PD in India (GAP-India) project aims to develop one of the largest clinical/genomic bio-bank for PD in India. Specifically, GAP-India project aims to: (1) develop a pan-Indian deeply phenotyped clinical repository of Indian PD patients; (2) perform whole-genome sequencing in 500 PD samples to catalog Indian genetic variability and to develop an Indian PD map for the scientific community; (3) perform a genome-wide association study to identify novel loci for PD and (4) develop a user-friendly web-portal to disseminate results for the scientific community. Our "hub-spoke" model follows an integrative approach to develop a pan-Indian outreach to develop a comprehensive cohort for PD research in India. The alignment of standard operating procedures for recruiting patients and collecting biospecimens with international standards ensures harmonization of data/bio-specimen collection at the beginning and also ensures stringent quality control parameters for sample processing. Data sharing and protection policies follow the guidelines established by local and national authorities.We are currently in the recruitment phase targeting recruitment of 10,200 PD patients and 10,200 healthy volunteers by the end of 2020. GAP-India project after its completion will fill a critical gap that exists in PD research and will contribute a comprehensive genetic catalog of the Indian PD population to identify novel targets for PD. [ABSTRACT FROM AUTHOR]

Background: Cobalamin deficiency, either due to dietary inadequacy or increased consumption attributable to levodopa-mediated metabolic disturbance, and resultant hyperhomocysteinemia may contribute to peripheral neuropathy (PN) in Parkinson's disease (PD). Aim: The aim of the study is to assess the prevalence of Vitamin B12 deficiency, hyperhomocysteinemia in Indian PD patients, and their association with PN. Materials and Methods: Clinical details were collected in 93 patients over a period of 2 years. Seventy controls were included in the study. Serum B12, homocysteine, folate, electroneurography, and autonomic function tests were done. The prevalence of B12 deficiency and hyperhomocysteinemia in PD patients and controls was assessed. The association of B12 and homocysteine levels with patients' age, disease duration, levodopa equivalent daily dose, cumulative levodopa dose, Unified Parkinson's Disease Rating Scale-III off score, modified Hoehn and Yahr score, and presence or absence of PN was studied. Results: Serum B12, homocysteine levels, prevalence of B12 deficiency, and hyperhomocysteinemia were no different between cases and controls. Seven of 93 (9.68%) PD patients had PN. The median values of serum B12, folate, and homocysteine levels across patients with or without PN could not be compared as only seven of our patients had PN. Conclusion: The prevalence of B12 deficiency, hyperhomocysteinemia, and incidence of PN among our patients is very less when compared to the Western population. The conjecture that PN in PD patients may be secondary to B12 deficiency/hyperhomocysteinemia stands as a speculation. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes mellitus (DM) is one of the most common non-communicable diseases associated with high morbidity and mortality. Electrolyte disturbances are not uncommon among in-hospital patients with DM. However, there are limited data on the magnitude of electrolyte disturbances in the diabetic population. Aim: To identify the common electrolyte disturbances among diabetic in-patients and to determine if there is an association of blood sugar control with electrolyte disturbances. Materials and Methods: A cross-sectional study was performed among patients admitted with a diagnosis of diabetes and without any restriction of any concomitant illness. Fasting, post prandial blood glucose, HbA1c, serum sodium, potassium, chloride, urea and creatinine were measured. The frequency of electrolyte disturbances was compared between those patients with well controlled vs. inadequately controlled blood sugar. Results: A total of 342 subjects participated in the study, of which 195 (57%) had uncontrolled DM. The frequency of hyponatremia, hypokalemia, hyperkalemia, hypochloremia and hyperchloremia was 33%, 16%, 6%, 31% and 2.7% respectively. In diabetic patients, hyponatremia was seen more commonly in patients with uncontrolled DM than those with well controlled blood sugars (38.46 vs 27.73%, p=0.01). Hypochloremia was more common among subjects with uncontrolled DM (23.65% vs 17.55%, p=0.01). The proportion of patients with hypokalemia or hyperkalemia did not differ between the two groups. Patients on insulin therapy were more likely to have hyponatremia than non-insulin users (p=0.01). Conclusion: Diabetic patients have an increased predilection to develop electrolyte disturbances. The most common electrolyte disturbance seen was hyponatremia and hypochloremia and they were widely prevalent among patients with uncontrolled DM. [ABSTRACT FROM AUTHOR]

Introduction: Sjogren's syndrome (SS) is a systemic autoimmune disease that apart from involving the exocrine glands can affect any organ. Involvement of the peripheral nervous system results in a wide spectrum of neuropathic manifestations.Objective: To evaluate the clinico-electrophysiological patterns as well as pathological characteristics of neuropathy in SS patients presenting to a neuromuscular clinic in a tertiary hospital from South India.Materials and Methods: This is a retrospective study from the Departments of Neurology, Rheumatology, and Pathology from Nizam's Institute of Medical Sciences. Twenty-one patients with the diagnosis of SS and peripheral neuropathy, seen between 2010 and 2016 were analyzed. Clinical records, conventional nerve conduction studies, and lip and nerve biopsy reports were collected.Results: Twenty one patients with SS had associated neuropathy. Female-to-male ratio was 2:1. In 14 (66.7%) patients, neuropathy was the initial manifestation, while in 4 (20%), exocrinopathy preceded neuropathy. The patterns of neuropathy included mononeuropathy multiplex (MNM) in 7 patients (30%), ganglionopathy in 4 (20%), length-dependant trigeminal autonomic neuropathy, and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) in 2 (10%), and cranial neuropathy in 1 (10%). Eighteen (86%) were seropositive with either anti Ro/SS-A or anti La/SS-B antibodies. Schirmer's test was positive in 13 (61.9%) patients. Nerve biopsy showed vasculitis in 5 patients and demyelinating and axonopathy in 2 patients each.Conclusions: We conclude that neuropathy is frequently the initial presentation of SS. MNM is the most common pattern followed by ganglionopathy. The pattern of neuropathy helps in arriving at the diagnosis of SS. Serology is a useful initial laboratory test. However,confirmation of SS is not by mere serology. Schirmer's test and lip biopsy are equally essential for the diagnosis, especially in seronegative patients when the clinical index of suspicion is high. [ABSTRACT FROM AUTHOR]

Background: Symptomatic Intracerebral hemorrhage (sICH) is a serious complication of recombinant tissue-plasminogen activator (rt-PA) therapy for acute ischemic stroke (AIS). Objective: To estimate the prevalence and predictors of sICH in patients after receiving IV rt-PA for AIS. Material and Methods: Consecutive patients of AIS thrombolysed between January 2010 and June 2016 in a University hospital in Hyderabad (India) were studied prospectively for sICH and it's various variables compared with the control group without sICH to determine any sigificantant difference. Results: Out of 113 patients , sICH was detected in 12 (10.61%) whose mean age(58±12.0 years) and gender ratio ( 2:1 ) was not statistically significant from controls. In s ICH group mean NIHSS score was 16.53± 5.81 vs 10.19± 5.06 in controls (p<0.001), gap between stroke onset and thrombolysis was 227.50±46.15 min vs 178.50± 69.20 min in controls(p=0.018).At presentation mean blood sugar was 208.75±90.97 mg/dl in sICH group vs 146.83±70.21 mg/dl in controls (p=0.002). Prior diabetes was in 7(53.30%) vs 23 (22.8%) in controls (p= 0.014)and hypertension in 11 (91.7%) vs (56(55.4%) in controls (p= 0.026) The mortality in sICH was 7 (58.30%)vs 4 (4.94%) in controls (p<.0.001). At 3 months mean mRS ofsICH patients was 5.57± 0.54 vs 2.17± 1.69 in controls (p<.05). Conclusion: High NIHSS score, increased stroke onset to thrombolysis time , high blood sugar at presentation ,prior diabetes and hypertension increase the chances of sICH. None of these contraindicate thrombolysing strokes but should caution the physician. [ABSTRACT FROM AUTHOR]

Background: It is a well-known fact that very few patients of stroke arrive at the hospital within the window period of thrombolysis. Even among those who do, not all receive thrombolytic therapy. Objective: The objectives of this study were to determine the proportion of early arrival ischemic strokes (within 6 h of stroke onset) in our hospital and to evaluate the causes of nonadministration of intravenous and/or intraarterial thrombolysis in them. Materials and Methods: Data of all early arrival acute stroke patients between January 2010 and January 2015 were included. Factors determining nonadministration of intravenous and/or intraarterial thrombolysis in early arrival strokes were analyzed. Results: Out of 2,593 stroke patients, only 145 (5.6%) patients presented within 6 h of stroke onset and among them 118 (81.4%) patients had ischemic stroke and 27 (18.6%) patients had hemorrhagic stroke. A total of 89/118 (75.4%) patients were thrombolyzed. The reasons for nonadministration of thrombolysis in the remaining 29 patients were analyzed, which included unavoidable factors in 8/29 patients [massive infarct (N = 4), hemorrhagic infarct (N = 1), gastrointestinal bleed (N = 1), oral anticoagulant usage with prolonged international normalized ratio (INR) (N = 1), and recent cataract surgery (N = 1)]. Avoidable factors were found for 21/29 patients, include nonaffordability (N = 7), fear of bleed (N = 4), rapidly improving symptoms (N = 4), mild stroke (N = 2), delayed neurologist referral within the hospital (N = 2), and logistic difficulty in organizing endovascular treatment (N = 2). Conclusion: One-fourth of early ischemic stroke patients in our study were not thrombolyzed even though they arrived within the window period. The majority of the reasons for nonadministration of thrombolysis were potentially preventable, such as nonaffordability, intrahospital delay, and nonavailability of newer endovascular interventions. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to develop and validate a predictor score for assessing the requirement of mechanical ventilation (MV) in patients with Guillain-Barre syndrome (GBS). Study design: The study was conducted in patients admitted with GBS in neurointensive care unit in a tertiary care hospital. The demographic, clinical factors, electrophysiological, and spirometric data of all consecutive patients were prospectively collected. The study was undertaken in 2 stages. In the first stage, data were collected for development of a predictor score. In the second stage, the score developed was validated on a separate set of patient data. Results: The data collected were compared between the 2 groups (ventilated vs nonventilated). On univariate analysis, time taken to reach maximum deficit, neck weakness, bulbar weakness, facial weakness, single breath count (SBC), forced vital capacity, and phrenic nerve latency predicted the need for MV. On multivariate analysis, only neck weakness, bulbar weakness, SBC, and forced vital capacity were independent predictors of MV. There was a good correlation between SBC and the spirometric tests and phrenic nerve distal motor latency, as reflected in receiver operating characteristics curve. The predictor score developed using the regression coefficient of independent predictors showed that the best cutoff score for prediction of ventilation was 60 (sensitivity, 0.95; 1 - specificity, 0.065). Internal cross validation of the neck weakness, SBC, and bulbar palsy (NSB) score showed good correlation (Pearson R = 0.76; P = .00). There was no statistically significant difference between predicted and observed outcomes (sensitivity, 95%; specificity, 93%). Conclusion: Several independent risk factors were found to predict the requirement for MV in patients with GBS at admission. However, after scoring and analyzing them, it was found that combining a few of them was more useful to predict the need for MV. A model using NSB score, developed using clinical variables, accurately predicted the requirement of MV. In addition, among the NSB score parameters, simple bedside SBC could adequately assess the adequacy of vital capacity. [ABSTRACT FROM AUTHOR]

Background: Despite the increasing burden of dementia in developing countries, mild cognitive impairment (MCI) continues to be underexplored. MCI has conventionally been identified based on clinical profile, but recently, biomarkers suggestive of Alzheimer's disease pathology have been included in the revised National Institute on Aging and the Alzheimer's Association (NIA-AA) criteria. In this study, we evaluated the profile of MCI in a memory clinic in India and explored the applicability of the revised NIA-AA criteria in a limited resource setting. Methods: Consecutive subjects evaluated at the memory clinic for mild memory complaints were included and underwent clinical and neuropsychological examination as well as standard brain imaging. A subset of patients was subjected to imaging biomarker studies as a part of routine clinical practice. Results: Among the 1,190 patients evaluated during the study period, 226 (19.0%) presented with mild memory complaints. Cerebrovascular disease was a common secondary cause. Nearly half of the patients (109 of 226) had MCI according to the modified Petersen criteria. All MCI subjects were educated and the majority were male. A total of 12% of the cohort was classified by imaging biomarkers as having MCI with intermediate likelihood of AD according to the NIA-AA criteria. Conclusion: In the setting of urban India, MCI is an emerging problem; therefore, it was feasible to operationalise the revised NIA-AA criteria in identifying subjects with MCI with intermediate likelihood of AD. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article evaluates the outcomes with regard to the surgical treatment method called deep brain stimulation of the bilateral globus pallidi interna which in used for the treatment of dystonia patients. Topics discussed include the factors which influence the outcomes, the best suited target for the procedure to be the globus pallidus interna and the long-term benefits of the procedure.

Background: Literature shows that home confinement during coronavirus disease 2019 (COVID-19) pandemic has significantly affected sleep. However, such information regarding subjects having Parkinson's disease (PD) is unavailable.Methods: This cross-sectional study was conducted using a questionnaire, developed and validated by experts. PD subjects from nine centers across India were included. Questionnaire assessed presence as well as change in sleep-related parameters and PD symptoms during home confinement. Restless legs syndrome (RLS) and REM sleep behavior disorder (REMBD) was diagnosed using validated questionnaire. Additionally, changes in physical activity, adoption of new hobbies during home confinement and perceived quality of life were assessed.Results: Of 832 subjects, 35.4% reported sleep disturbances. New-onset/worsening of sleep disturbances (NOWS) was reported by 23.9% subjects. Among those with sleep disturbances (n = 295), insomnia symptoms worsened in half (51.5%) and nearly one-fourth reported worsening of RLS (24.7%) and REMBD (22.7%) each. NOWS was common in subjects lacking adequate family support during home confinement (P = 0.03); home confinement > 60 days (P = 0.05) and duration of PD > 7 years (P = 0.008). Contrarily, physical activity >1 h/day and engagement in new hobbies during home confinement were associated with better sleep. NOWS was associated with worsening of motor as well as non-motor symptoms of PD (P < 0.001) and poorer life quality (P < 0.001).Conclusion: Home confinement during COVID-19 pandemic was significantly associated with NOWS among PD subjects. NOWS was associated with global worsening of PD symptoms and poorer life quality. Physical activity >1 h/day and adoption of new hobbies during home confinement were associated with better sleep. [ABSTRACT FROM AUTHOR]

Clinical practice guidelines for Wilson's disease (WD) have been published by the American Association for the Study of Liver Diseases and European Association for the Study of the Liver in 2008 and 2012, respectively. Their focus was on the hepatic aspects of the disease. Recently, a position paper on pediatric WD was published by the European Society of Pediatric Gastroenterology Hepatology and Nutrition. A need was felt to harmonize guidelines for the hepatic, pediatric, and neurological aspects of the disease and contextualize them to the resource-constrained settings. Therefore, experts from national societies from India representing 3 disciplines, hepatology (Indian National Association for Study of the Liver), pediatric hepatology (Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition), and neurology (Movement Disorders Society of India) got together to evolve fresh guidelines. A literature search on retrospective and prospective studies of WD using MEDLINE (PubMed) was performed. Members voted on each recommendation, using the nominal voting technique. The Grades of Recommendation, Assessment, Development and Evaluation system was used to determine the quality of evidence. Questions related to diagnostic tests, scoring system, and its modification to a version suitable for resource-constrained settings were posed. While ceruloplasmin and 24-h urine copper continue to be important, there is little role of serum copper and penicillamine challenge test in the diagnostic algorithm. A new scoring system – Modified Leipzig score has been suggested with extra points being added for family history and serum ceruloplasmin lower than 5 mg/dl. Liver dry copper estimation and penicillamine challenge test have been removed from the scoring system. Differences in pharmacological approach to neurological and hepatic disease and global monitoring scales have been included. Rising bilirubin and worsening encephalopathy are suggested as indicators predicting need for liver transplant but need to be validated. The clinical practice guidelines provide recommendations for a comprehensive management of WD which will be of value to all specialties. [ABSTRACT FROM AUTHOR]