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Objective: ESPRITE (Study 508; NCT03836924) evaluated the real‐world safety, tolerability, and efficacy of adjunctive perampanel in patients aged ≥12 years with focal‐onset seizures (FOS), with or without focal to bilateral tonic–clonic seizures (FBTCS), in India. Methods: ESPRITE was a prospective, multicenter, single‐arm, observational, Phase IV study with a 6‐month Treatment Period. Patients were aged ≥12 years and had been prescribed perampanel for adjunctive treatment of FOS, with or without FBTCS. Assessments included incidence of treatment‐emergent adverse events (TEAEs; primary endpoint), median percent reduction in seizure frequency per 28 days from baseline, 50% responder rates, and seizure‐freedom rates. Results: Overall, 200 patients were enrolled (199 patients in the Safety Analysis Set and 174 patients who completed all visits in the main efficacy analyses). TEAEs (all mild or moderate in severity) were reported in 18.1% (n = 36/199) of patients (the most common were dizziness [3.0%] and irritability [2.0%]). TEAEs leading to discontinuation of perampanel were reported in 2.0% of patients; no deaths or serious TEAEs occurred. At 6 months, median percent reduction in seizure frequency was 100.0%, 50% responder rate was 83.3%, and seizure‐freedom rate was 49.4%. Significance: Adjunctive perampanel (at a mean daily dose of 4 mg/day) was shown to be well tolerated and effective in patients aged ≥12 years with FOS, with or without FBTCS, from India. Plain Language Summary: Many patients do not receive adequate treatment for epilepsy and need effective seizure control medications. In this 6‐month clinical study, 199 patients from India, aged 12 years or older, added perampanel to the anti‐seizure medications they were already taking. At 6 months, 49% of patients experienced no seizures since starting perampanel and seizure frequency was reduced by half in 83% of patients. Side effects occurred in 18% of patients (most commonly dizziness and irritability) and caused 2% to stop perampanel; no deaths were reported. Perampanel was an effective and generally safe added medication for patients with epilepsy from India. [ABSTRACT FROM AUTHOR]

Background: Assessment of wild edible vegetables (WEVs) from the ethnobotanical approach is a significant key to understanding indigenous knowledge systems. The available literature has revealed a tremendous decline in knowledge of WEVs over the last few decades. The main purpose of this study was to document and analyse the traditional knowledge of WEVs among the two major ethnic groups of Mizoram regarding their use and the diversity associated with the importance of traditional medicines. Secondly, a market survey will be conducted to determine the status of available WEVs. Methods: This study conducted an ethnobotanical survey among 72 informants through semi-structured interviews and questionnaires besides direct field observations. The documented data were quantitatively analysed using various ethnobotanical indices, including Informant's consensus factor (ICF), Fidelity level value (Fl), and Direct matrix ranking (DMR). A marketing survey was conducted in the Bara Bazar, Mizoram's most prominent local market. A total of 38 vendor informants were interviewed to observe and collect the price of commonly sold WEVs. Results: A total of 70 WEVs, distributed in 58 genera under 36 families, were documented and identified. Of these, 33 WEVs were of medicinal importance. Leafy vegetables were documented as the most frequently consumed parts (55.71%). The majority (44.29%) of the plants documented were consumed in fried form. The highest level of agreement among informants for food used categories was observed for plants combined with dry fish (ICF = 1). The Informant's consensus factor (ICF) of disease categories ranges from 0.75 to 1, with the highest being reported for convulsion (ICF = 1), sleep inducer (ICF = 1), and antiseptic (ICF = 1). Picria fel-terrae was the most preferred plant for hypertension treatment (100% FL). Direct matrix ranking (DMR) indicated that Dysoxylum excelsum was highly utilized by the inhabitant for multipurpose species (DMR = 64). Jaccard similarity index (JI) between the two ethnic groups was revealed at 1.26. Forty-seven WEVs were found to be commercialized in the Bara Bazar market, Aizawl, with a price range from 0.1 to 2.4 USD. Ensete superbum was reported as near threatened per the IUCN Red List of Threatened Species. Conclusion: This work highlighted the importance and rich diversity of WEVs in Mizoram, which are presently used among different age groups for food and medicine. Informants have good knowledge of WEVs, which was shared to a great extent among the inhabitants; this legacy of traditional culture must be conserved. This study further suggests a priority setting for conserving multipurpose WEVs in human-inhabited sites, investigating the recorded species' nutritional properties and pharmacological activities. [ABSTRACT FROM AUTHOR]

The diagnostic utility of HLA B51 (Human Leukocyte Antigen) in association with Behçet's disease(BD) has been identified. However, the clinical manifestations of HLA B51 positive patients who have not satisfied the criteria for Behcet's have been rarely reported. Our objective was to study the clinical profile of HLA B51 positive patients and to include them under the spectrum of International criteria for Behcet's disease (ICBD) and the modified Japanese criteria, and also to study the outcome in these patients. This is a retrospective prospective observational study conducted over 3 years (2018-2021) in HLA B51 positive patients. The clinical presentations, treatment given and follow up response to treatment were observed. In the study cohort of 28 HLA-B51 positive patients, mean age was 41.7 years. 17 (60.7%) had oral ulcers, 5 (17.8%) genital ulcers, 7 (25%) skin lesions, 11 (39.2%) had Pathergy positivity, 19 (67.8%) ocular, 7 (25%) neurological, 3 (10.7%) Gastrointestinal (GI) and 3(10.7%) had vascular manifestations.12 (42.8%) satisfied ICBD criteria and 2 (7%) satisfied Japanese criteria for BD. 15 (53.5%) were given immunosuppressant therapy with [Azathioprine (AZA) in 10(35.7%), Mycophenolate mofetil (MMF) in 4(14.2%) and cyclophosphamide (CYC) in 1(3.5%)]. Biologics were given in 7 (25%) with [Adalimumab(ADA) in 6(21.4%) and Rituximab (RTX) in 1(3.5%)]. Our study showed female predominance, with more ocular manifestations, oral aphthous ulcers and less gastrointestinal involvement. Azathioprine (AZA) showed better response compared to Mycophenolate mofetil (MMF). [ABSTRACT FROM AUTHOR]

Background: Functional movement disorders (FMDs) and functional seizure (FS) are the two most important subcategories of functional neurologic disorders (FNDs). Objectives: This study aimed to discern similarities and differences between patients with FMD and FS. Methods: A prospective comparative study of 94 patients with FNDs (FMD = 47, FS = 47) was conducted. Results: Tremor and pauci-kinetic attack with preserved responsiveness were the most common subtypes observed in patients with FMD and FS, respectively. A significantly higher number of patients with FMD had more than one precipitating factor (P = 0.03). Headache was significantly more common in patients with FS (P = 0.03). More patients came for follow-up in the FMD group (P = 0.01). More patients in the FS group reported "very much improvement" (P = 0.04), and "no change" was more commonly reported by the FMD group patients (P = 0.009). Conclusion: Emotional stress was the most common precipitating factor in patients with FMD and FS. The prognosis was better in patients with FS. [ABSTRACT FROM AUTHOR]

Bell's mania is the co-occurrence of delirium and mania. We present two cases of Bell's mania in a neurosurgical setting. The first case is of a 52-year-old male who presented with holocranial headache, disorientation, and manic symptoms for five months. He was found to have suprasellar craniopharyngioma. He significantly improved with olanzapine, but re-emergence of mood symptoms was noted after surgery. The second case is of a 42-year-old male who presented with a 15-day history of seizures and disorientation. He was found to have a dural arteriovenous fistula. He developed Bell's mania in the post-procedural period, which improved with olanzapine. Compression of the hypothalamo-pituitary stalk in the first case and vascular and inflammatory changes in the second case could have led to Bell's mania. Atypical age of onset and presence of neurological symptoms in patients presenting with psychiatric symptoms should raise the suspicion of an underlying organicity. Atypical anti-psychotics can be a useful management strategy for Bell's mania. [ABSTRACT FROM AUTHOR]

Background: Neonates are at higher risk for the development of seizures due to various reasons, however diagnosis of neonatal seizures is difficult to establish because of varied aetiologies involved. Seizures are one of the most common risk factor for neonatal mortality and subsequent long term neurological sequelae. Objectives: To evaluate the clinical profile and aetiology in relation to onset of neonatal seizures in tertiary care centre Methods: This was a hospital based Cross-sectional, observational study done in a Neonatal ICU of Department of Paediatrics, Old Government General Hospital, Siddhartha Medical College, Vijayawada, AP, and India. The study was conducted over a period of 1 year from April 2021 to March 2022. Based on inclusion and exclusion criteria, 100 neonates were found eligible. Parents of all these 100 neonates provided informed consent to participate in the study. They were evaluated with necessary investigations, EEG for incidence, aetiological factor, and clinical types found in neonatal seizure. Results: Out of 696 NICU admissions during study period, seizures occurred in 100 neonates. Demographic profile of maternal population shows in table-1. 46% of women were aged 25 to 30 years at the time of delivery. 15% of mothers gave a history of infections. This indicates that NS occurs in a few cases due to maternal infections. Other maternal risk factors found that 10% of mothers had gestational diabetes mellitus, 5% had placental abnormalities, 2% had cord prolapse, and 6% had pre-eclampsia. 3% had previous neonatal seizures babies. 58% of neonates were males in the current study. There is significant association between gestational age and outcome, as per chi square analysis (P=0.0001). There is significant association between birth weight and outcome, as per chi square analysis (P=0.0001). Conclusion: To conclude it is of utmost important to improve antenatal and perinatal care of pregnant women to reduce the incidence of birth asphyxia, which was the most common cause of neonatal seizure in our study. To reduce morbidity and death from neonatal seizures, we recommend early genetic screening for newborns. [ABSTRACT FROM AUTHOR]

This article examines the connection between opioid use disorder and seizures during opioid withdrawal, specifically focusing on a case series from North India. The use of opioids in India varies across different regions, with some areas being more affected than others. The article presents eight cases of individuals with opioid use disorder who experienced seizures after ceasing opioid use. These patients displayed symptoms such as loss of consciousness, jerky movements, and frothing from the mouth. The article investigates potential causes for these seizures and compares them to existing research. The study found that the occurrence of seizures during opioid withdrawal has increased in certain areas. The patients in the study were treated with a combination of buprenorphine and naloxone, which alleviated withdrawal symptoms and prevented further seizure episodes. The article also explores potential causes for the seizures, such as the adulteration of opioids with other substances and neurodegenerative changes resulting from long-term inhalation of aluminum. The study emphasizes the importance of accurate diagnosis and treatment for seizures during opioid withdrawal. [Extracted from the article]

Background: The term seizure is used to describe abnormal, uncontrolled paroxysmal electrical activity of brain, literature suggests that about 8 -10% of population may experience at least one episode of seizure. Neuroimaging studies like CT scan brain is recommended in adult patients with new onset seizures to determine the underlying cause, structural abnormality, and the possibility of recurrence. Because of its capacity to quickly rule out an intracranial haemorrhage or a tumour requiring immediate neurosurgical intervention, CT scan remains the first -line imaging technology in most acute care settings. Aims and Objectives: To Evaluate the CT scan study in new onset seizure and to identify a lesion in CT scan that can explain the seizure. Materials and methods: Eighty-five patients (age 18 and above) were studied in the outpatient and inpatient department of medicine of a tertiary care centre of central India from 1st July 2019 to 30th June 2021. All patients fulfilling inclusion criteria were subjected to detailed clinical history, examination including neurological examination, and aetiology and characteristics of seizure were co related with CT scan findings. Results: The majority of patients were presented with focal seizures 55 (55%) and with generalised seizures 45(45%). Seizures are more prevalent in age 18 to 40. the prevalence of seizures was higher in males 60% than in females 40%. The abnormal CT scan findings were found in 50.6% cases where seizure were secondary to CVA infarct in 16.5%cases, whereas CVA IP bleed was noted in 10.6% ICSOL was noted in 16.6% cases, with tuberculoma and neurocysticercosis in 5.9% and 4.7% cases respectively. [ABSTRACT FROM AUTHOR]

Canine distemper virus (CDV) is a major global pathogen of dogs affecting multiple organ systems of the body and causing the characteristic malady with prominent neurological manifestation. Natural CDV infections with typical clinical symptoms in domestic cats are not yet reported in Kerala, India, even though a few reports on the occurrence of fatal canine distemper in large felids exist. The present study reports a documented preliminary report of the natural canine distemper virus infection in a domestic cat from Kerala, India, with typical neurological manifestations. An unvaccinated adult female domestic cat was presented to the University Veterinary Hospital with the acute onset of neurological signs, viz. typical continuous myoclonus like in a CDV-infected dog and tonic-clonic seizures in between the short intervals of time. The rapid immunochromatography revealed the presence of canine distemper viral antigens on ocular, nasal and faecal samples, and the hemogram revealed thrombocytopenia and severe leukocytosis with granulocytosis, lymphocytosis and monocytosis. The animal responded well to the symptomatic therapy for viral encephalitis and recovered within 24 h to apparent normalcy, except for the myoclonus. The recurrence of acute encephalitic symptoms was reported after 45 days, and the animal died due to uncontrolled seizures by day 90, as the owner was unwilling to provide further veterinary aid for the animal. This case indicates the need for screening the cats with neurological signs for CD and further molecular characterisation of the strains involved. [ABSTRACT FROM AUTHOR]

Background: The past two decades have seen significant debate around cannabis legalization globally, including in India. Since there is no data on professionals’ attitudes toward cannabis legalization; we aimed to assess early-career psychiatrists (ECP) views on cannabis legalization. Methods: An online survey consisting of questions regarding personal and socio-demographic details, attitudes toward legalization of medicinal cannabis and recreational cannabis, and potential indications of medicinal cannabis use was distributed to ECPs. Data from 105 respondents were analyzed using descriptive statistics, chi-square test, and t-test. Results: More respondents agreed with the legalization of medical cannabis (55%) as compared to recreational cannabis (23%). More than 80% ECPs considered cannabis to be associated with psychosis and adverse mental health outcomes; however, those in favor of legalization considered cannabis to be less harmful. ECP with past cannabis use was more likely to have a permissive attitude toward the legalization of recreational cannabis (χ2 =6.79, p < .05) but not for medicinal cannabis use (χ² =1.96, p > .05). Conclusion: ECP in India are open to the idea of legalizing cannabis for medicinal purposes but not for recreational purposes. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To study neuroimaging in partial seizures in children aged 2 to 12 years. To identify treatable causes of partial seizures. Methods: All children between 2-12 years of age, who presented to the Emergency Department of Pediatrics, Mallareddy Medical College for Women, Telangana, between January 2022 to March 2023, with partial seizures will undergo neuroimaging, plain and contrast (contrast where indicated). Results: The study population has fallen into two different age groups (1) 2 to 6 years (2) 6-12 years due to significant difference of incidence of partial seizures in the two age groups 68% belonged to 2-6 years age group, 32% belonged to 6-12 years age group. A total of 158 children were brought to Emergency service Room with partial seizures, among which 100 cases were included in the study, excluding those children falling under the exclusion criteria. Among the 100 children, 13% had simple partial seizures, 21% had partial seizures with secondary generalization, while 66% had complex partial seizures representing the largest group. 63% of the children had abnormal EEG, 75% of the children had abnormal CT brain. Both CT brain and EEG were abnormal in 60% of the cases, which shows that significant number of cases are diagnosed by CT brain and EEG. The lesions detected in CT brain in this study are neurocysticercosis (32%), tuberculoma (26%), infarct (5%), AV malformation (2%), calcifications (4%), Hydrocephalus (3%), subdural effusion (2%), brain tumor (1%). The neuroinfections namely neurotuberculoma and neurocysticercosis itself accounted for 58% of the total cases of partial seizures, 77% of the total abnormal CT brain, the 'P' value is 0.013 which is significant. Conclusion: In tropical developing countries like India, neuroinfections are the most common cause of partial seizures. ILAE recommends CT brain as diagnostic tool whenever MRI is unavailable or unaffordable as it provides equivalent diagnostic aid. Neuroimaging and EEG are strongly advised. Most partial seizure etiologies are treated medically or surgically in children presenting to the emergency room. [ABSTRACT FROM AUTHOR]

Background: Etiological profile of seizure is different from region to region owing to socio, economic and cultural differences between countries. Etiological profile will determine the outcome along with mortality and morbidity associated with the disease. Few studies till date report the etiological profile in adult new onset seizures. Aim: We here report a study to evaluate the etiological profile in adult patients reporting their first seizure at a tertiary hospital with the objective of identifying the variation in aetiology pertaining to socio economic status and prevalent culture of the population. Material and methods: Hundred adult patients (18years and above) presenting with new onset seizures, were recruited over a period of one year and evaluated for identification of the cause of their seizures. Results: Neuro infections (37%) were the most commonly observed cause of seizure in the present study. Males (male: female 1.22:1) were predominantly affected and generalized tonic clonic seizures (GTCS) was the predominant seizure type observed in these participants. Conclusion: Tuberculous meningitis was the most common cause due to its endemic nature in the area of study. Stroke was the most common cause in adults over 50 years while, in younger adults neuro infection was the leading cause in the present study group. Etiological profile of a population is dependent on the socio-economic status and prevalent culture of the population. [ABSTRACT FROM AUTHOR]

Aim and Objectives: The purpose of this study is to determine the prevalence of metabolic anomalies associated with neonatal convulsions. It was chosen to study the relationship between the early clinical symptoms and neonatal seizures. Methods: Hospital-based, prospective study of newborns admitted to a department of paediatric DR VRK, Women's Medical College, Aziz Nagar, Hyderabad, Telangana, India, within the first 28 days of life. 50 infants participated in the trial, which ran from March 2022 to February 2023. The most common type of infant metabolic abnormalities was observed in this investigation. Results: From day 1 to day 17, the median age at first seizure start was 3.26 (95% CI 2.40 to 2.72). Thirty-three of the seizures (33%) in our study began during the first 24 hours, while others began between 24 and 72 hours (days 1-3), 4 to 7 days (days 4-7), and beyond 7 days (9%). Nearly nine in ten cases of convulsions occur on day one. 14 (56%) premature infants had mild seizures, 7 (28%) of which were tonic and 4 (16%) were clonic. Conclusion: Newborns frequently experience convulsions. The numerous causes of newborn seizures affect the course of the condition and its long-term neurological prognosis, mortality, and morbidity. [ABSTRACT FROM AUTHOR]

Objectives: Nearly 40% of pediatric epilepsies have a genetic basis. There is significant phenotypic and genotypic heterogeneity, especially in epilepsy syndromes caused by sodium channelopathies. Sodium channel subunit 1A (SCN1A)-related epilepsy represents the archetypical channel-associated gene that has been linked to a wide spectrum of epilepsies of varying severity. Subsequently, other sodium channels have also been implicated in epilepsy and other neurodevelopmental disorders. This study aims to describe the phenotypes in children with sodium channelopathies from a center in Southern India. Materials and Methods: This is a retrospective, descriptive, and single-center study. Out of 112 children presenting with epilepsy who underwent genetic testing between 2017 and 2021, 23 probands (M: F = 12:11) were identified to have clinically significant sodium channel mutations. Clinical presentation, electroencephalography, and imaging features of these patients were recorded. The utility of genetic test results (e.g., in planning another child, withdrawal of medications, or change in treatment) was also recorded. Results: Age at onset of seizures ranged from day 4 of life to 3.5 years. Clinical epilepsy syndromes included generalized epilepsy with febrile seizures plus (n = 3), Dravet syndrome (n = 5), early infantile epileptic encephalopathy (n = 7), drug-resistant epilepsy (n = 5), and epilepsy with associated movement disorders (n = 3). The most common type of seizure was focal with impaired awareness (n = 18, 78.2%), followed by myoclonic jerks (n = 8, 34.78%), epileptic spasms (n = 7, 30.4%), bilateral tonic-clonic seizures/generalized tonic-clonic seizures (n = 3, 13%), and atonic seizures (n = 5, 23.8%). In addition to epilepsy, other phenotypic features that were discerned were microcephaly (n = 1), cerebellar ataxia (n = 2), and chorea and dystonia (n = 1). Conclusion: Sodium channelopathies may present with seizure phenotypes that vary in severity. In addition to epilepsy, patients may also have other clinical features such as movement disorders. Early clinical diagnosis may aid in tailoring treatment for the given patient. [ABSTRACT FROM AUTHOR]

Intracranial granulomas are a major cause of seizures in India, the most common etiologies being neurocysticercosis and tuberculosis. However, other pathologies including rare low-grade tumors may mimic these granulomas on imaging. In this article, we presented the case of a young woman patient with drug-resistant epilepsy. On imaging, there was a small calcified lesion in the brain parenchyma. In view of concordant electroclinical and imaging data on presurgical evaluation, the lesion was excised and the patient was seizure free. On histopathological evaluation, it was found to be a polymorphous low-grade neuroepithelial tumor of the young (PLNTY) – a rare, recently reported entity that can mimic an intracranial granuloma on imaging. [ABSTRACT FROM AUTHOR]

Background: Out of 108 paediatric traumatic brain injuries admitted from January 2023 to December 2023, only 3 patients have early post traumatic seizures who had received phenytoin prophylaxis. Aim: To find out the prevalence of early post traumatic seizure in pediatric traumatic brain injuries despite phenytoin prophylaxis. Methods: In this prospective study all the paediatric traumatic brain injuries admitted to department of neurosurgery, Guntur medical college during 1st January 2023 to 31 st December 2023 are studied. Results: Among 108 patients admitted with traumatic brain injuries, only 3 patients have early post traumatic seizures who had received phenytoin prophylaxis. Conclusion: This is a study conducted at a district headquarter medical college level with radial population habitation and having highway proximity. Its having both urban and rural population in its catering area. Regular and multicentric studies will provide comprehensive and distinctive data about the usefulness of prophylactic phenytoin in prevention of early post traumatic seizures in traumatic brain injuries in this vast subcontinent of India. [ABSTRACT FROM AUTHOR]

Background: Estimating the morbidity and mortality in the emergency department (ED) only allows the pediatricians to assess the prognosis of the patient and plan therapies accordingly. This study was conducted to develop and validate a simple scoring system and establish a correlation between clinical parameters and the outcome of the patient. Subjects and Methods: Nine parameters, i.e., body temperature, respiratory rate, heart rate, blood pressure (BP), pulse oxygen saturation (SpO2), capillary refill time, level of sensorium, presence of seizure, and random blood sugar level, were documented, at the time of admission. Parameters were assigned a score of "0" if it is normal. An abnormality in the above parameters were indicated by a score ranging from 1 to 3. The primary outcome was assessed in terms of death/survival. Results: Out of the total, 57.2% required critical care, and mortality was reported in 14.75% of cases. On univariate analysis, seven clinical parameters were significantly associated with mortality. In multivariate logistic regression analysis, abnormalities in BP, SpO2, and temperature were independent predictors of mortality (P < 0.05). The receiver operating characteristic was 0.798 (95% confidence interval, 0.755-0.836; P < 0.0001) for the outcome of mortality (the predictive ability of score of 79.8%). The patients with scores 1-5, 6-10, and >10 had 4.923, 23.143, and 112.0 higher odds of mortality, respectively. Conclusions: This scoring system predicts the severity of illness and outcome with a sensitivity of 71.19% and specificity of 72.14%, respectively, in the ED. Higher scores predict unfavorable outcomes in these children. [ABSTRACT FROM AUTHOR]

Background: Neonatal sepsis has been a major cause of neonatal mortality and morbidity globally. Late onset sepsis is on the rise mostly due to better health care services and improved survival of premature neonates. Gram-negative sepsis has emerged as a major public health problem constituting significant morbidity and mortality. There is limited data on gram-negative late onset sepsis from the central part of India, therefore this study was conducted at a tertiary care center from rural part of India. Objectives: To determine the clinical profile and outcome among neonates with gram-negative late onset sepsis. Design: It is a retrospective analysis conducted among neonates with gram-negative late onset sepsis at a tertiary care center from central India. Methods: All neonates below 28 days of age suspected to have late onset sepsis were enrolled in the study. The data for the period of January 2019 to December 2021 was collected and analyzed using software SPSS version 29. The outcome variables studied were discharge (good outcome) and death (poor outcome). Results: In the present study, overall prevalence of gram-negative late onset sepsis was 4.8%. Respiratory distress (52.2%), seizure (18.9%), jaundice (15.6%), and lethargy (15.6%) were common clinical symptoms among neonates with sepsis. The most common organism isolated was Klebsiella spp. (36.7%) followed by Acinetobacter spp. (31.1%) and E. coli (17.8%). Low gestational age (n = 20 vs n = 7, P =.002) and low birth weight (n = 33 vs n = 4, P =.02) were associated with poor outcomes in neonates with gram negative LOS. The overall mortality rate was found to be 30% among neonates with gram negative sepsis. Conclusion: The prevalence of gram-negative sepsis was found to be 4.8%. Factors associated with poor outcome in gram-negative sepsis were low birth weight, and prematurity. Klebsiella spp. was found to be a common cause of gram-negative LOS, therefore, the empiric antibiotic policy must provide coverage against these micro-organisms. [ABSTRACT FROM AUTHOR]

The calcified stage of the neurocysticercosis (NCC) is the common cause of acquired epilepsy in low and middle income countries in people aged > 20 years. Approximately 30% of adult onset seizures and epilepsy are attributable to NCC. In India and some of the Latin American countries, epilepsy due to solitary calcified NCC is the common adult onset epilepsy. The current evidence suggests that the calcified cysticercus granuloma is probably the epileptogenic focus. The mechanisms involved in the epileptogenic process are not well understood; Focal-onset seizures with or without impaired awareness are the common seizure type. Focal-onset seizure can evolve to bilateral tonic-clonic seizure. Seizure outcome with anti-seizure medication, most often with monotherapy, is very good. The seizure disorders associated with various stages of NCC can be preventable. [ABSTRACT FROM AUTHOR]

Introduction: A seizure is a brief change in normal electrical brain activity resulting in alterations in awareness, perception, behaviour, or movement, which affect persons of all ages, but are particularly common in childhood. Seizure is a serious neurological symptom in the Paediatric Intensive Care Unit (PICU), yet data on the clinical spectrum of seizures occurring in the PICU setting in India are scarce. Aim: To determine the aetiology, clinical and radiological features of seizures in critically ill children admitted to PICU at a tertiary care hospital. Materials and Methods: This retrospective study was conducted at Gauhati Medical College and Hospital, Guwahati, Assam, India, from April 2017 to September 2018. A total of 253 children aged between 29 days to 12 years, admitted to PICU with seizures were enrolled in the study. Data regarding demographics, diagnosis, clinical seizures, associated diagnosis, Electroencephalogram (EEG) features, imaging, length of stay in PICU, and in-hospital mortality were collected. Data was presented in frequencies, mean, standard deviation. Results: In present study, male to female ratio was 1.5:1 with mean age of 48.9±44.5 months. The most common causes of seizures in PICU setting were acute symptomatic in 185 (73.1%) and epileptic in 68 (26.9%) patients. Central Nervous System (CNS) infections constituted 15.8% of the PICU admissions following seizures. Most frequent co-existent diagnosis at admission was infectious diseases in 96 (38%) patients, followed by pulmonary diseases in 28 (11%) and cardiologic diseases in 14 (5.5%). Conclusion: CNS infections are the most common cause of acute symptomatic seizure, while non infectious diseases such as metabolic disorders, epilepsy and immune disorders also contribute to seizure occurrence in PICU. Identification of common seizure aetiologies in PICU is important step for a prompt and effective treatment. [ABSTRACT FROM AUTHOR]

Introduction: Neonatal seizure is defined as paroxysmal electrical discharge from the brain. The immature brain seems more prone to seizures. The incidence was found to increase with decreasing gestation and birth weight-preterm neonates (20.8 vs. 8.4 per 1000 live-births) while very low birth weight neonates had more than 4-fold higher incidence (36.1 per 1000 live-births). Objective: The study was conducted to estimate the incidence, etiological factor, time of onset, clinical types, and biochemical abnormalities among the different types of neonatal seizures. Methods: This is a hospital based prospective observational study conducted in NICU, Department of Pediatrics, SMIMER during the period of January 2020 to March 2021. Results: Total patients with neonatal seizures were 90 in our study. Incidence of neonatal seizures in our study was 1.1%. Incidence was higher in pre-term neonates (4.8%) and more in males (56.67%). Incidence of neonatal seizures was higher in LBW babies (4.3%) and more common in SGA babies (51.11%). Incidence among vaginal delivered babies was 0.9%, LSCS was 1.7% and forceps was 1.1%. Birth asphyxia (41.1%) was the most common cause of all neonatal seizures followed by hypoglycemia (17.8%), neonatal meningitis/septicemia (14.5%), hypocalcemia (12.2%), ICH (7.8%). Subtle seizures (44.4%) were the most common type of seizure followed by tonic (38.9%), focal clonic (11.1%), multifocal clonic (5.6%). 33.3% of neonatal seizures occurred in < 24hrs & 40% in 24-72 hrs. The most common biochemical abnormality was hypoglycemia (17.8%) followed by hypocalcemia (12.2%). Conclusion: Incidence of neonatal seizures was 11.1/1000 live births (1.1%) & more common in preterm, LBW & LSCS deliveries. Birth asphyxia was the most common cause and subtle seizures were the most common type of seizure. Subtle seizures were more common in 24-72 hours of life. Most common biochemical abnormality was hypoglycemia followed by hypocalcemia. [ABSTRACT FROM AUTHOR]

Anti N-meihyl D-aspartate receptor encephalitis (NMDAR-E) though rare, is currently considered as the commonest antibody mediated encephalitis in the world. No review on perspectives of NMDAR-E from India is available. The aim of the study was to review all the cases of NMDAR-E reported from India until June 2021 in terms of clinical features, diagnosis, and treatment, and perform a comparison of adult and paediatric cases. A literature review of NMDAR-E case reports/case series published from India till June 2021 was done. Demography, clinical profile, triggers, electroencephalography (EEG), neuroimaging, treatment details and outcomes were analysed. Sixteen case series and 35 case reports with a total of 249 cases were analysed. 82% of cases were from paediatric age group. The female to male ratio was 3:1. Psychiatric deficits, movement disorders, seizures, and language abnormalities were the most common clinical features. MRI brain abnormalities were seen in 45% patients. Electroencephalographic abnormalities were seen in 85% of patients. Infective triggers (herpes simplex virus and various other agents) were reported in 11% of the cases. Pediatric patients as compared with adults had more encephalopathy, autonomic dysfunctions, and normal imaging whereas the latter had more cognitive dysfunctions and delta brush pattern in electroencephalography (p<0.005). Therefore, to conclude, this literature review suggests that overall, the clinical spectrum of Indian cases is like cases described from other parts of the world. However, most reported cases from India belonged to paediatric age group who had more encephalopathy, autonomic dysfunctions, and normal brain imaging compared to adults. A few novel infectious agents as triggers were described from India. [ABSTRACT FROM AUTHOR]

Background: Clozapine has well-documented inter-ethnic variations in pharmacokinetics. There is a paucity of data about clozapine use and associated adverse events such as seizures, obsessive compulsive symptoms, neutropenia, and agranulocytosis, from India. Methods: This retrospective cohort study followed up 228 patients initiated on clozapine in a tertiary care referral center in India for an average of 10 years. We calculated incidence rates of new-onset seizures, new-onset obsessive compulsive symptoms, agranulocytosis, and neutropenia. We collected data on doses of clozapine used and serum assays and calculated concentration-to-dose (C/D) ratios. We also collected relevant clinical details about clozapine-induced seizures. Results: In the sample, 16.8% had new-onset seizures, 12.3% had new-onset OC symptoms, 2.7% had neutropenia, and 0.9% had agranulocytosis. The mean C/D ratio was 2.09 (SD = 1.8). Almost half (46.3%) of available serum assays were in the supra-therapeutic range. Seizures were associated with a higher clozapine dose at one year (OR = 1.003; 95%CI = 1.000–1.006; P value = 0.045) and the presence of positive psychotic symptoms at one year (OR = 4.214; 95%CI = 1.894–9.373; P < 0.001). Conclusion: Compared to existing literature, Indians have a higher rate of clozapine- related seizures and need lower doses to reach therapeutic serum levels. [ABSTRACT FROM AUTHOR]

Introduction: Ketogenic diet (KD), well-accepted therapy for drug-resistant epilepsy (DRE), can be tried on an outpatient basis, thereby reducing the need of hospitalization/starvation. Here, we analyze the efficacy and safety profile of outpatient-based KD in children with DRE with particular reference to ratios of the KD. Materials and Methods: Children aged 0-18 years enrolled between 2008 and 2018, under "Keto Kid Project"--an outpatient-based project were included in this study. Demographic and clinical details, investigation profile in terms of epilepsy, and suitability for diet were noted. Diet was initiated at lower ratios and slowly increased on a case-to-case basis. For the purpose of the analysis, subjects were divided into two groups based on their maintenance ratios: higher ratios (>3:1) and lower ratios (≤3:1). Seizure control, other benefits in terms of behavior and side effect profile were reviewed. Results: A total of 117 of 138 children enrolled in program who had completed three months on diet were taken for analysis. A total of 97 of 117 were on lower maintenance ratios and 20 of 117 on higher ratios at the time of analysis. Lennox-Gastaut syndrome was the most common syndromic diagnosis followed by West syndrome in both groups. Retention of diet was higher in children on lower ratios. Although the consistency of ketosis was higher in those on higher ratios, seizure control was similar across both groups. Antiepileptic drugs (AED) reduced significantly after diet (P = .0016) among both groups with no difference between each other. Other beneficial effects included alertness and improved behavior across both groups. The main reasons for withdrawal were frequent infections, lack of benefit, and poor compliance. Both groups had a similar incidence of side effects. Conclusions: Seizure control, reduction of AED burden, and behavioral benefits of the diet using locally available food recipes (vegetarian and nonvegetarian) were noteworthy in this study. Ketosis and seizure control can be effectively maintained on lower ratios. [ABSTRACT FROM AUTHOR]

Background: Citrobacter freundii is a common cause of neonatal intensive care unit (NICU) outbreaks, causing high morbidity and mortality as a hospital-acquired pathogen. This is the first study from our geographic region, which makes it of utmost importance for spreading awareness about this unusual pathogen amongst healthcare settings. Aim: Investigating an outbreak caused by C. freundii in the NICU of a tertiary care hospital. Settings and Design: During the month of May 2023, an outbreak of C. freundii causing neonatal septicaemia was suspected in the NICU of a tertiary care hospital in Western Uttar Pradesh. The outbreak was investigated and surveillance conducted by the hospital infection control (HIC) team, to find a source of the infection by root cause analysis (RCA), to study clinical profiles and outcomes, to determine their antimicrobial susceptibility pattern, to take corrective action preventive action (CAPA). Materials and Methods: A total of 132 blood samples were tested for blood culture and sensitivity using the BD FX40 system. Positive flagged bottles were processed for Gram stain and sub-cultured on 5% sheep blood agar and MacConkey's agar media plates. Final bacterial identification and antibiotic susceptibility were done with an automated BD-Phoenix M-50 system. Results: C. freundii with similar antimicrobial susceptibility was identified in seven neonates, contributing to a major percentage of neonatal blood culture positivity of 13.7%, out of a total positivity rate of 38.63%. The mortality rate of this outbreak was 28.57%. The HIC team investigates this outbreak for CAPA and RCA. On environmental surveillance, C. freundii was isolated from infant incubators, dressing trolleys, and laryngoscope blades of the NICU. Discussion: C. freundii association in Blood culture from critical areas patients is life-threatening 'Consociatio Vita Minabatur Procursus'. Direct access to the bloodstream causing neonatal septicaemia in a short time is a concern for its potential severity, making it as 'Periculosus Pathogen'. Laboratory automation and implementation of strict infection control strategies in critical areas can improve clinical outcomes and prevent future outbreaks. [ABSTRACT FROM AUTHOR]

Background: Posterior reversible encephalopathy syndrome (PRES) is characterized by altered mental status, headaches, visual disturbances, and seizures and caused due edema affecting mainly the parietal and occipital lobes of the brain. This clinical entity is increasingly established due to improvements in radiological investigations. Patient's Concern: We present a 22-year-old female with 9-month amenorrhea with altered sensorium; the noncontrast computed tomography head showed ill-defined hypodensities in the bilateral occipital and parietal region suggestive of the PRES. Intervention: The patient was managed immediately with an injection of levetiracetam with intravenous (IV) fluids, antibiotics, and IV steroids. The patient had gross improvement in the sensorium and vision within 24 h. The patient was discharged on the 10th day of admission with 100% recovery. Follow-ups at 2 and 4 weeks were uneventful. Lesson Learnt: Even dengue can cause PRES, so the clinical entity should be recognized as early as possible. The treatment should be initiated urgently; knowledge of this can easily prevent unnecessary morbidity and mortality with complete recovery. [ABSTRACT FROM AUTHOR]

Background: To look into the frequency of metabolic abnormalities connected to newborn convulsions, in the newborn section of the Department of Pediatrics, Government Medical College, Ongole, Andhra Pradesh, India. It was decided to do research on the clinical signs as soon as they appeared and how they related to neonatal seizures. Material and Methods: Retrospective hospital-based research approach on neonates hospitalised to a Department of Pediatrics, Government Medical College, Ongole, Andhra Pradesh, India, from birth until 28 days after birth. The trial, which lasted from January 2022 to November 2022 involved 100 newborns. This study identified the metabolic abnormality is the most common cause of neonatal seizures. Results: The mean seizure onset day was 3.26, ranging from 1 to 17. (95% CI 2.40 to 2.72). In our study, 33 seizures (33%) started within 24 hours, 24--72 hours (days 1--3), 4--7 days (days 4--7), and more than 7 days (9%) respectively. Convulsions on the first day account for 91%. Mild seizures were experienced by 14 (56%) preterm babies; 7 (28%) of them were tonic, and 4 (16%) were clonic. There were mild, tonic, and clonic seizures in 75 term newborns. Preterm infants in my study experienced 56% more mild seizures than term infants. Compared to term babies, preterm infants experienced 28% fewer tonic seizures. 16% of preterm and 14.6% of natal clonic seizures occur. Conclusion: Convulsions in newborns are frequent. The progression of the disease as well as its long-term neurological prognosis, mortality, and morbidity are influenced by the various causes of newborn seizures. Quick assessment, diagnosis, and strong treatment are required to stop these consequences. Biochemical anomalies may be the primary or secondary issue. Transient abnormalities have a good prognosis and are simply treated. The prognosis and outcome of the newborn are improved and neurological repercussions are avoided when metabolic disorders are treated early. [ABSTRACT FROM AUTHOR]

Open reading frame variants which lack stop codons such as C12orf57 variants are known to cause Temtamy syndrome, an extremely rare disorder characterized by intellectual disability, seizures, facial dysmorphism and agenesis of corpus callosum. C12orf57 was initially reported to be required for human corpus callosum development. We report the first child who is of Indian origin with developmental and epileptic encephalopathy (DEE) with a unique phenotypic evolution as focal onset reflex seizures. We performed whole exome sequencing of genomic DNA isolated from peripheral blood samples of proband and his parents. Two pathogenic compound heterozygous variants, a start loss variant (Chr12:7053285:c.1A>G) and a premature stop gain variant (Chr12:7053327:c.43C>T), involving the C12orf57 gene were identified in the proband. Our case report which details genotyping in this rare syndromic developmental encephalopathy, with no prior cases reported from India, expands the ethnic spectrum of patients. [ABSTRACT FROM AUTHOR]

Background: Though severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) virus primarily affects respiratory system, neurological involvement is well known. Aims: To describe the neurological manifestations of coronavirus disease 2019 (COVID 19) during three waves of the pandemic. Methodology: This was an ambispective observational single centre study to describe the neurological manifestations of COVID 19 infection among inpatients from a tertiary care referral centre in Western India from March 2020 to January 2022. Results: Out of 14,822 patients admitted with COVID 19, 307 (2.07%) had neurological manifestations. Neurological manifestations were seen in 1.87% in first wave (onset to 10 Feb 21); 2.37% in second wave (Feb 11, 2021 to Dec 31, 2021) and 6.26% in third wave (Jan 1, 2022 to Jan 31, 2022). The most common neurological manifestations were encephalopathy (34.5%), ischemic stroke (32.1%), and acute symptomatic seizures (8.8%). Encephalopathy (p = 0.028) was more common in first wave while seizures were more common in third wave (p = 0.001). In patients with encephalopathy, hypoxia (p = 0.0001), shock (p = 0.001), renal involvement (p = 0.002), and sepsis (p = 0.033) were associated with higher mortality; while those with no systemic involvement had better survival (p = 0.0001). Among patients with ischemic stroke, 32.1% did not have any traditional vascular risk factors. These patients were 9 years younger and required 6 days less hospitalization than patients of stroke with vascular risk factors. Conclusion: SARS CoV 2 produces many central and peripheral nervous system manifestations. Encephalopathy was more common in first wave while acute symptomatic seizures were more common in third wave. Encephalopathy was most common neurological manifestation with progressively higher mortality with increased number of systemic comorbidities. Ischemic stroke was seen in patients who had vascular risk factors as well as in patients without them. [ABSTRACT FROM AUTHOR]

Background: Metachromatic leukodystrophy (MLD) is an autosomal recessive lysosomal disorder due to the deficiency of arylsulfatase A enzyme. Materials and Methods: This is a retrospective analysis of all clinically suspected MLD cases and confirmed by genetics, enzyme assay, and/or nerve biopsy between June 2015 and May 2020 at a tertiary care center. The clinical profile, enzyme levels, nerve conduction studies, MRI of the brain, and variants of ARSA gene causing MLD were analyzed. Results: Out of the 19 cases of MLD, four were juvenile, and the rest were late infantile variants. Eleven were male. The mean age of presentation in the late infantile variant was 28.4 months, and that of the juvenile variant was 44.5 months. The clinical features of the late infantile variant were developmental delay (30.75%), neuroregression (100%), spasticity (66.6%), dystonia (66.6%), small head (60%), whereas the juvenile variant presented with gait difficulties and neuroregression in all (100%), and seizures in 3 (75%). MRI of the brain showed bilateral symmetrical confluent white matter T2 hyperintensities with sparing of subcortical-U-fibers in all cases. The tigroid pattern was seen in two cases. Normal enzyme level was seen in one, but this child had a pathogenic variant PSAP gene resulting in saposin B deficiency. The targeted next-generation sequencing was done in 11/19 cases and showed ARSA gene variant in 10 and PSAP gene in one child. Nerve conduction studies were done in 12 children, and all showed features suggestive of demyelinating motor polyneuropathy. Nerve biopsy showed metachromatic granules in four children. Conclusion: MLD can present with a developmental delay with or without regression, with or without seizures, with normal or small head. MRI and nerve conduction studies are helpful in diagnosis. Normal enzymes do not rule out MLD. Nerve biopsy may be useful in non-affordable families. [ABSTRACT FROM AUTHOR]

Aim: The aim of this article is to describe the hippocampal characteristics among children with calcified neurocysticercosis (cNCC). Materials and Methods: This cross-sectional study was conducted among children with epilepsy aged 3-14 years diagnosed with cNCC. Patients showing evidence of cNCC, with prior serial imaging evidence of active NCC, were enrolled. Eligible participants were subjected to magnetic resonance imaging (MRI)-based protocol and sleep-deprived electroencephalography. Hippocampal characteristics on the MRI were described. Results: A total of 31 children with mean (SD) age of 10.3 (3.2) years with cNCC were enrolled in the study. We observed that 42% (13/31) of children with cNCC had borderline (10-20% difference in the volumes of right and left hippocampi) (n = 8) or clear (>20% difference) (n = 5) hippocampal atrophy. Among 31 children with cNCC, 27 (87.1%) had nidus within the lesion and 21 (67.7%) had perilesional gliosis. Conclusion: Children with cNCC are at risk of seizure recurrence on tapering anti-seizure medications. Our study with limited sample size revealed that hippocampal atrophy and perilesional gliosis are prevalent among children with cNCC, predisposing them to the risk of epilepsy. [ABSTRACT FROM AUTHOR]

Background Kyasanur Forest disease (KFD) is a viral zoonotic disease where patients present with febrile illness and haemorrhagic manifestations in the first phase. In a small fraction of patients, the fever may be biphasic. This study aimed to describe the neurological manifestations of patients with KFD in the first and second phases of the illness. Methods This is a retrospective cohort study of 297 patients admitted with a molecular diagnosis of KFD from December 2018 to December 2020. The case records of these patients were reviewed for evidence of neurological involvement. Results A total of 34 (11.5%) patients in the first phase and 16 (36.4%) patients in the second phase had neurological involvement. Altered sensorium, seizures and focal infarcts were common in the first phase, while cerebellar signs and leptomeningeal enhancement were common in the second phase. Conclusions Neurological involvement is seen in both phases of KFD. While in the first phase it is a result of possible encephalitis/encephalopathy, the second phase involvement is possibly due to postinfectious cerebellitis or meningitis. [ABSTRACT FROM AUTHOR]

Background: Breakthrough seizures occur in 37% of epilepsy patients even though remission has been attained. Counseling on precipitating factors form an integral part of treatment along with anti-epileptic drugs (AEDs). Identification of precipitating factors may help in reducing unnecessary hospitalization and complications of breakthrough seizures. Materials and Methods: This retrospective study was conducted in a tertiary healthcare center in Puducherry. All children with epilepsy admitted with breakthrough seizures from January 2017 to December 2019 were included in the study. Those with neonatal seizures, diagnosis of either Neurocysticercosis or tuberculoma, cases without seizure free period of 6 months and case records without adequate details were excluded. Data regarding precipitating factors were collected from case records and analyzed using SPSS version 24.0 software. Results: Of the 80 children included in the study, mean age was 4.98 (±3.52) years and 56.3% were less than 5 years of age. In total, 90% (n = 72) of the participants had generalized epilepsy, of which 67 had generalized seizures, four had absence seizures and one had atonic seizures. Majority (85%) reported at least one possible precipitating factor for breakthrough seizures and common ones were fever (27.5%) and non-compliance to medication (26.25%). Most common reason for non-compliance was forgetting to take medication (38%). Also illiterate mothers and multiple AEDs had a significant association with non-compliance (P < 0.05). Conclusion: The results of our study stress the need on adequate counseling about possible precipitants and prescription on minimum AEDs whenever possible. Parents need to ensure strict adherence to AEDs and avoidance of trigger factors. [ABSTRACT FROM AUTHOR]

Background: Seizures due to an underlying metabolic abnormality form an important subset of acute symptomatic seizures in that they are treatable and do not require long-term anticonvulsants. The objective of this study is to determine the clinical and etiological profile of children with metabolic seizures. Materials and Methods: A prospective observational study done in children admitted with acute symptomatic seizures who had an underlying metabolic abnormality as the cause of seizures from January 2018 to December 2019 in a tertiary care hospital of South India. Demographic and clinical parameters were noted and relevant investigations including biochemical, neuro imaging, cerebro spinal fluid analysis, electro encephalography were carried out accordingly. Results: Among 1256 children admitted with new onset seizures, 408 (32.5%) had acute symptomatic seizures exclusive of febrile seizures and unprovoked seizures, of which 46 (3.7%) were found to have an underlying metabolic abnormality and were analyzed. The ratio of male to female was 1.4:1 and the peak age was infancy, accounting for 62.5%. The leading causes of metabolic seizures included hypocalcemia in 28 (60.9%), hypoglycemia in 16 (34.8%), and hyponatremia in 2 (4.3%). Vitamin D deficiency in 21(75%) was found to be the commonest cause for hypocalcemia, followed by hypomagnesemia, hypoparathyroidism, osteopetrosis, and renal failure. The various causes of hypoglycemia were Addisons disease in 6(37.5%), hyperinsulinemic hypoglycemia, idiopathic ketotic hypoglycemia, glycogen storage disorder, and fatty acid oxidation defect, congenital adrenal hyperplasia, and Laron syndrome. Both children with hyponatremia were diagnosed as congenital adrenal hyperplasia. Conclusion: Metabolic seizures accounted for 3.7% of new onset seizures and 11.3% of acute symptomatic seizures in our study. Hypocalcemia (60.9%) was found to be the commonest cause of metabolic seizures in children with the majority due to vitamin D deficiency (75%). Addison's disease (37.5%) was found to be the common cause for hypoglycemia. It is reasonable to estimate serum calcium, magnesium, electrolytes, and glucose in all children presenting with new onset seizures. [ABSTRACT FROM AUTHOR]

Background: Posterior reversible encephalopathy syndrome (PRES) is a reversible condition. The Main pathological feature is vasogenic cerebral edema with predominant involvement of posterior part of the cerebrum. Clinical symptoms range from headache, seizure, and vision loss. We evaluated the clinicoradiological features of patients with PRES and their clinical outcome. Materials and methods: A retrospective study with 30 cases from January 2014 to May 2017. Results: Of thirty patients, 18 were females and twelve patients were male. The Mean age of the patients was 38.6 years. The most common presentation was seizure (66.6%) followed by altered mental status (53.3%) and headache (40%). The Main comorbid illnesses in our study were renal disease (36.7%), hypertension (23.3%), eclampsia, and postpartum sepsis (26.7%). The Most common site was the occipito-parietal region in the magnetic resonance imaging brain (66%). Atypical presentation involved the temporal lobe (16%), basal ganglia (6%), and microhemorrhage (6%). The Outcome was good with 20% mortalities. Conclusion: PRES is a reversible condition and has a good outcome in most patients. In our study, seizure was the most common presentation and renal disease is the most common comorbid illness. [ABSTRACT FROM AUTHOR]

Background: The term seizure is used to describe abnormal, uncontrolled paroxysmal electrical activity of brain, literature suggests that about 8 -10% of population may experience at least one episode of seizure. In adult patients with new onset seizures, neuroimaging studies like MRI brain are advised to find out the underlying cause, structural abnormality, and the likelihood of recurrence. For neuroimaging, CT scan and MRI both can be done but for detection of cerebral lesions, imaging with MRI is considered superior to CT scan. MRI becomes essential, because of its superior depiction of brain anatomy and tissue composition. Aims and Objectives: To Evaluate the MRI brain study in new onset seizure and to identify a lesion in MRI brain that can explain the seizure. Materials and methods: sixty-nine patients (age 18 and above with new onset seizures) were studied in the out-patient and in-patient department of medicine of a tertiary care centre of central India from 1st July 2019 to 30th June 2021. All patients fulfilling inclusion criteria were subjected to detailed clinical history, examination including neurological examination, and etiology and characteristics of seizure were co related with MRI brain findings. Results: The majority of patients were presented with focal seizures 38(55%)and with generalized seizure 31(45%). Seizures are more prevalent in age 18 to 40 years. The prevalence of seizures was higher in males (60%) than in females (40%). MRI brain revealed abnormal findings on 68.1% cases with new onset seizures. MRI revealed CVA in 17.3% cases (infarct in 13% and bleed in 4.3%), tuberculoma in 7.2% and neurocysticercosis in 5.8% cases, viral and tubercular meningitis in 4.3% cases each, Cortical Venous Thrombosis was noted in 8.7% cases, AV Malformations, Mesial temporal lobe sclerosis, Posterior reversible encephalopathy syndrome (PRES) and Dyke Davidoff Masson Syndrome were noted in 2.9% cases each. [ABSTRACT FROM AUTHOR]

Cerebral creatine deficiency syndromes (CCDS) are a group of potentially treatable neurometabolic disorders. The clinical, genetic profile and follow up outcome of Indian CCDS patients is presented. This was a retrospective cohort of CCDS patients seen over six-years. Diagnosis was based either on low creatine peak on proton magnetic resonance spectroscopy (MRS) and/or genetic evaluation. Thirteen patients were eligible [8 creatine transporter deficiency (CTD), 4 guanidinoacetate methyltransferase (GAMT) deficiency and 1 could not be classified]. The mean (±SD) age at diagnosis was 7.2(±5.0) years. Clinical manifestations included intellectual disability (ID) with significant expressive speech delay in all. Most had significant behavior issues (8/13) and/or autism (8/13). All had history of convulsive seizures (11/13 had epilepsy; 2 patients only had febrile seizures) and 2/13 had movement disorder. Constipation was the commonest non-neurological manifestation (5/13 patients). Cranial MRI was normal in all CTD patients but showed globus pallidus hyperintensity in all four with GAMT deficiency. MRS performed in 11/13 patients, revealed abnormally low creatine peak. A causative genetic variant (novel mutation in nine) was identified in 12 patients. Three GAMT deficiency and one CTD patient reported neurodevelopmental improvement and good seizure control after creatine supplementation. Intellectual disability, disproportionate speech delay, autism, and epilepsy, were common in our CCDS patients. A normal structural neuroimaging with easily controlled febrile and/or afebrile seizures differentiated CTD from GAMT deficiency patients who had abnormal neuroimaging and often difficult to control epilepsy and movement disorder. [ABSTRACT FROM AUTHOR]

Objective: The bio-psycho-social factors affecting the quality of life in patients with epilepsy can be numerous but are often overlooked. The behavioral side effects of anti-seizure medications can be one such potential factor. The aim of the study is to address the effect of the number of anti-seizure medications on the development of psychiatric comorbidity and quality of life in patients with adequate seizure control. Materials and Methods: The study recruited 100 participants with generalized tonic-clonic seizures from a tertiary care center in North India, who were seizure-free from the last 1 month. The study participants were divided into two groups based on whether they were on monotherapy or polytherapy. The two groups were matched for their socio-demographic and clinical profile. We assessed for psychiatric comorbidity in each group using Mini International Neuropsychiatric Interview. All the study participants were given Hindi translated version of quality of life in the epilepsy-31 questionnaire for objective assessment of the quality of life. Results: The patients receiving anti-epileptic polytherapy had significantly higher prevalence of psychiatric comorbidity than patients on monotherapy. Furthermore, the patients on polytherapy scored significantly less on the cognitive domain of quality of life as well as the overall quality of life domain in the epilepsy-31 questionnaire. Conclusion: The patients with epilepsy must be evaluated for psychiatric comorbidity and side effect profile of anti-seizure medications to improve the quality of life. This is particularly more important for patients who are on anti-epileptic polytherapy even if the seizure control is adequate. [ABSTRACT FROM AUTHOR]

Background: Though reports of neurological manifestations of COVID-19 have emerged from various parts of the world, the cohorts reported are from the West and mostly derived from electronic databases. Much remains unknown regarding neuro-COVID in developing countries. India is the second-worst affected country, and this study reports the neurological manifestations of COVID-19 in a comprehensively evaluated cohort. Objective: The aim of this study was to describe the range of neurological manifestations of COVID-19 in India with an emphasis on the risk factors, laboratory and imaging findings and short-term outcome. Methods: Retrospective review of hospital records of all confirmed COVID-19 patients with neurological manifestations, receiving inpatient care in two neurology referral hospitals were done. All demographic, clinical details, investigations, and treatment were analysed. Results: A total of 120 confirmed COVID-19 cases presenting with neurological symptoms were included. The mean age of illness and duration of illness was 48.03 ± 17.3 years and 10.9 ± 17.3 days respectively. New onset of neurological symptoms occurred in 100 cases while 20 patients had worsening of pre-existing neurological illness. Stroke was the commonest neurological disorder (43%), followed by encephalopathy (23%) and Guillain-Barre syndrome (10%). Other unusual neurological manifestations included new-onset headache (7%), seizures including denovo status epilepticus (5%) and meningo-encephalitis (5%). Nearly half of the patients had preceding COVID-19 symptoms. Poor outcome at discharge was seen in 40% and mortality occurred in 15%. Conclusion: Stroke and encephalopathy constitute the most common neurological manifestations. The absence of preceding COVID-19 symptoms in nearly half the cases is striking. Poor outcome was seen in nearly 50% despite early recognition and management. [ABSTRACT FROM AUTHOR]

Objective: To describe the long-term outcome in children with acute ischemic stroke (AIS) from a tertiary-care center. Materials and Methods: Prospective, observational study of children diagnosed with AIS between the ages of six months and 12 years and who completed two to five years of follow-up. Results: Forty-nine children (35 boys, 14 girls) were included. The mean age at onset of stroke was 35.6 ± 31.5 months (6–108 months). A majority of children had presented with hemiparesis (93.8%). Risk factors were identified in 65.4% of cases. Moyamoya vasculopathy (28%), iron-deficiency anemia (24.4%), and trauma (12.2%) were the most common risk factors. The majority of infarcts were cortical (32.6%), followed by combined cortical and subcortical (30.6%), and isolated subcortical (26.5%). At follow-up, recurrent stroke (24.4%), residual epilepsy (24.4%), and motor disability requiring support for ambulation (6%) were noted. The mean general developmental score (GDS) was 71.2 ± 18.7. Global developmental delay in 46.9% and delayed social intelligence in 22.4% was noted. On subset analysis, children had physical (42.9%), cognitive (34.7%), communication (30.6%), adaptive-behavior (26.5%), and social–emotional (22.4%) delay. Predictors of good cognitive outcome were younger age at onset (OR 0.964, P = 0.006), isolated subcortical infarcts (OR 26.386, P = 0.028), and absence of seizures at presentation (OR 0.197, P = 0.044). Predictors of poor social quotient were seizures at onset (OR 0.049, P = 0.012) and recurrent stroke (OR 0.055, P = 0.012). Conclusion: Neurodevelopmental problems and epilepsy occur in a significant proportion of children with AIS in the long term. Good outcomes are predicted by the younger age of onset, subcortical infarcts, absence of seizures, and absence of recurrence of stroke. [ABSTRACT FROM AUTHOR]

The article discusses how Guillain Barre Syndrome is associated with Scrub Typhus infection, a a zoonotic disease, caused by Rickettsia, Orientia tsutsugamushi (OT). Topics include Treatment given including intravenous immunoglobulin (IVIG) or Plasma exchange (PE); and temporal association in the present study supports the notion that GBS might have been triggered by humoral immune response against ST.

Objective: To ascertain whether epileptic seizure control during pregnancy differed between Australian women with previously surgically treated epilepsy, and those with only medically treated epilepsy. Materials/Methods: Analysis of data for 74 pregnancies of women with surgically treated focal epilepsy, compared with that from 1013 pregnancies in women with medically treated focal epilepsy, both groups drawn from the Australian Register of Antiepileptic Drugs in Pregnancy between 1999 and 2020. Results: Seizures of all types, and also convulsive seizures, were less well controlled during pregnancy in the previously surgically treated cases, the difference for seizures of all types (68.9% versus 50.1%) being statistically significant (p <.05). This result was contrary to the outcome of a previously published study of the same question carried out in India. Conclusions: At present, it may be premature to conclude that previous epilepsy surgery will be associated with a better chance of seizure‐free, or seizure‐controlled, pregnancy. [ABSTRACT FROM AUTHOR]

Background and Objective: SARS-CoV-2 infections present with predominant respiratory symptoms. Only a few anecdotal reports of neurological involvement have come out from India so far. Adverse neurological events following immunization (AEFI) were also reported. We present the neurological symptoms seen either in association with vaccination or COVID-19 infection during the second wave. Methods: This was a retrospective study that included consecutive COVID-19 patients' admissions during the second wave of COVID-19 pandemic in two tertiary health care centres in Kerala. Neurological symptoms two weeks prior or thirty days after a positive status of antigen or RTPCR was termed as COVID-19-Associated Neurological Disorders (CAND) and those with neurological symptoms within one month of COVID-19 vaccination was termed as Post-Vaccinal Neurological Disorders (PVND). Results: During the study period, 1270 COVID-19 admissions were reported. We identified neurological symptoms in 42 patients (3.3%), of which 35 were CAND and 7 were PVND. Stroke was the most common (50%), followed by seizures and peripheral nervous system disorders (14.2% each). Encephalitis/demyelination (11.9%) and COVID-19-associated infections (9.5%) were also seen. Conclusion: During the SARS-CoV-2 pandemic, CAND and PVND have been emerging. Association of some of these may be fortuitous; however it is worth mentioning as pathogenic mechanisms of COVID-19 affecting various organ systems still remain unclear. Moreover, this may be helpful in future studies designing management options. [ABSTRACT FROM AUTHOR]

The article presents a study on postictal headache with a single neurocysticercal lesion. Topics discussed include similarities between seizure and headache, study finding on patients with neurocysticercosis (NCC), and characteristics of patients with generalized seizures and patients with NCC. The limitations of the study are also mentioned.

Background: Dengue is a common endemic infection in India. Neurological complications involving various parts of the neuro-axis have been reported. We report neurological complications amongst dengue patients admitted to a tertiary hospital in Western India. Materials and Methods: Patients admitted in a tertiary hospital in Western India with dengue infection and having neurological symptoms were included in this study. Their history, physical examination, laboratory investigations and imaging studies were obtained from the inpatient records and analysed. Results: Between January 2014 to December 2019, a total of 5821 patients were diagnosed with dengue. Of these, 154 (2.64%) had neurological manifestations. Encephalopathy in a setting of multisystem involvement was seen in 31.2% patients, encephalitis with focal features, abnormal imaging and/or abnormal cerebrospinal fluid (CSF) examination was seen in 15.6%, syncope in 27.3% and acute symptomatic seizure in 11.0%. Less common presentations were intracranial haemorrhage (4.5%), Guillain-Barre syndrome (GBS) (3.2%), optic neuritis (1.9%), myositis (1.3%), hypokalemic paralysis (1.3%), ischemic stroke (0.6%), posterior reversible encephalopathy syndrome (PRES) (0.6%), myoclonus (0.6%) and brachial plexopathy (0.6%). Conclusions: In this study of patients admitted with dengue, neurological complications due to dengue were seen in 2.64%. Encephalopathy, encephalitis and syncope were the commonest manifestations, followed by acute symptomatic seizures, intracranial haemorrhage and GBS. The entire neuroaxis can be involved in dengue infection. To the best of our knowledge, this is the largest reported study of neurological complications of dengue. [ABSTRACT FROM AUTHOR]

Background: Temporal lobe epilepsy is the most common type of focal onset seizure. Focal onset seizure with impaired awareness, previously known as complex partial seizure (CPS), account for 18–40% of all seizure types. Hippocampal sclerosis (HS) is the most common cause of temporal lobe epilepsy, which produces focal onset seizure with impaired awareness. It may be detected in MRI visually, but bilateral abnormalities are better identified using volumetric analysis. We aimed to compare hippocampal volume in patients with focal onset seizure with impaired awareness visually and quantitatively. Methodology: This cross-sectional study includes clinically diagnosed cases of 56 focal onset seizure with impaired awareness undergoing MRI at a tertiary teaching hospital in the southern part of India for a duration of 18 months from February 2018 to August 2019. Results: Out of 53 patients studied using 1.5 T MRI brain with seizure protocols, hippocampal atrophy was identified visually in 13 (24.5%) on the right side, 9 (16.98%) on the left side, and in 6 (11.32%) bilaterally. However, with volumetry, hippocampal atrophy (not taking T2 signal change) was detected in 15 (28.30%) on the right side, 10 (18.86%) on the left side, and in 7 (13.20%) bilaterally. Hippocampal volumes between ipsilateral and contralateral seizure focus were found to have no significant difference (p-0.84). Conclusions: Though visual analysis is efficient in the diagnosis of pathology, MR volumetry may be used as an expert eye in cases of subtle volume loss. [ABSTRACT FROM AUTHOR]

Sickle cell disease (SCD) is a group of hemoglobinopathies that vary in severity, the most severe form, homozygous sickle cell anemia, is more commonly associated with neurologic complications. These are attributed to the vaso-occlusion and micro obstruction in the circulation of the central nervous system. The incidence of various neurologic complications in SCD ranges from 6% to 30% in various series. The commonly reported in literature include silent cerebral infarction (SCI), ischemic stroke, transient ischemic attacks (TIAs), headaches, seizures and neurocognitive impairment. However, hemorrhagic complications like subarachnoid hemorrhage (SAH), hemorrhagic stroke, extradural and subdural hematomas, especially in absence of trauma are rarely thought of. We report three uncommon spontaneous hemorrhagic manifestations of sickle cell anemia -- one case of parenchymal (intracerebral) bleed who presented with acute onset of parkinsonism and two cases of extradural hematoma (EDH) of which one patient had recurrent EDH at the same site which is hitherto not reported in the literature. [ABSTRACT FROM AUTHOR]

Background: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is one of the common causes of treatable encephalitis in children characterized by severe memory deficit, speech disturbances, seizures, autonomic dysfunction, and movement disorders. Hemiparesis/stroke-like episode is not a usual presenting complaint of NMDAR encephalitis. The objective of this study was to report confirmed cases of seropositive anti-NMDAR encephalitis in children who presented with hemiparesis/stroke-like episodes. Materials and Methods: Retrospective review of charts of patients with a diagnosis of NMDAR encephalitis was performed at the pediatric neurology department attached to a tertiary care hospital for 6 years from March 2014 to February 2020. Only those case records with NMDAR seropositivity in the cerebrospinal fluid were collected and those who presented with stroke-like episode/hemiparesis were retrieved separately and the data were extracted in a predesigned proforma and analyzed. Results: Six children of 24 seropositive anti-NMDAR encephalitis presented with hemiparesis/stroke-like episode. All the six patients presented with hemiparesis, behavioral changes, and regression of speech. Three children had seizures and one child had Epilepsia partialis continua. Two children had dystonia and choreoathetosis. Methylprednisolone followed by oral steroids were administered in all patients. Cases 1, 2, and 4 made a full recovery within 7 days, but cases 3, 5, and 6 showed improvement after 20 days following additional IVIG. Four children have cognitive decline and behavioral problems. Case 6 had relapse and recovered with rituximab. Conclusion: Anti-NMDA receptor encephalitis which is a potentially treatable disease should be considered in the differential diagnosis when a child presents with hemiparesis/stroke-like episode. [ABSTRACT FROM AUTHOR]

Introduction: Malaria is one of the major life-threatening health problems in most of the tropical countries. Children are the most vulnerable group accounting for 67% of all malaria-associated deaths worldwide. Southern Haryana is typically endemic for malaria. Therefore, the present study was undertaken to describe the clinical presentation of complicated malaria and correlate clinical complications with malarial species. Materials and Methods: It was an observational cross-sectional study conducted in the Department of Microbiology along with Department of Pediatrics, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Nuh, Haryana. A total of 100 children with severe malaria admitted in the pediatric ward, confirmed by peripheral blood smear and rapid diagnostic test, were included. Results: Out of 100 cases admitted, majority were due to Plasmodium vivax (73%), followed by mixed (18%) and Plasmodium falciparum (9%) infection. Children below 5 years were more infected (57%). Male preponderance was seen (55%). Fever was the most common symptom observed (95%). Pallor was the most common sign observed (85%). Among severity parameters, the most common were severe anemia (41%), jaundice (17%), abnormal bleeding (17%), convulsions (15%), and acute respiratory distress syndrome (7%). The case fatality rate was 3%. Conclusion: P. vivax was previously known to cause benign malaria. The present study found that P. vivax mono-infection can cause severe malaria in children and should no longer be considered as benign malaria. [ABSTRACT FROM AUTHOR]