175 results on '"Madhu Nagappa"'
Search Results
2. Impact of COVID-19 on guillain-barre syndrome in India: A multicenter ambispective cohort study
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Yareeda Sireesha, Ritu Shree, Madhu Nagappa, Anuja Patil, Monika Singla, M V Padma Srivastava, R K Dhamija, Neetha Balaram, Abhishek Pathak, Dileep Ramachandran, Sujit Kumar, Inder Puri, Sudhir Sharma, Samhita Panda, Soaham Desai, Priyanka Samal, Aditya Choudhary, Pamidimukkala Vijaya, Teresa Ferreira, S S Nair, H P Sinha, S K Bhoi, Joseph Sebastian, Sanjay Sharma, Aneesh Basheer, Manish Bhartiya, N L Mathukumalli, Shaikh Afshan Jabeen, Vivek Lal, Manish Modi, P Praveen Sharma, Subash Kaul, Gagandeep Singh, Ayush Agarwal, Divyani Garg, James Jose, Priya Dev, Thomas Iype, Maya Gopalakrishnan, Ashish Upadhyay, Rohit Bhatia, Awadh K Pandit, Rajesh K Singh, Manish Salunkhe, P M Yogeesh, Alisha Reyaz, Nishant Nadda, Menkha Jha, Bismay Kumar, P K Kushwaha, Harshadkumar Chovatiya, Bhavani Madduluri, P Ramesh, Abeer Goel, Rahul Yadav, and Venugopalan Y Vishnu
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areflexia ,covid-19 ,gbs ,guillain–barré ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Introduction/Aims: Studies conducted during the coronavirus disease 2019 (COVID-19) pandemic have reported varied data regarding the incidence of Guillain–Barre syndrome (GBS). The present study investigated demographic and clinical features, management, and outcomes of patients with GBS during a specified period of the COVID-19 pandemic, and compared these features to those of GBS in the previous year. Methods: A multicenter, ambispective cohort study including 26 centers across India was conducted. Data from a pre-COVID-19 period (March 1 to August 31, 2019) were collected retrospectively and collected ambispectively for a specified COVID-19 period (March 1 to August 31, 2020). The study was registered with the Clinical Trial Registry India (CTRI/2020/11/029143). Results: Data from 555 patients were included for analysis: pre-COVID-19 (n = 334) and COVID-19 (n = 221). Males were more commonly affected during both periods (male:female, 2:1). Gastroenteritis was the most frequent antecedent event in 2019 (17.4%), whereas fever was the most common event in 2020 (10.7%). Paraparesis (21.3% versus [vs.] 9.3%, P = 0.001) and sensory involvement (51.1% vs. 41.3%; P = 0.023) were more common during COVID-19 in 2020, whereas back pain (26.3% vs. 18.4%; P = 0.032) and bowel symptoms (20.7% vs. 13.7%; P = 0.024) were more frequent in the pre-COVID period. There was no difference in clinical outcomes between the two groups in terms of GBS disability score at discharge and 3 months after discharge. Independent predictors of disability in the pre-COVID period included areflexia/hyporeflexia, the requirementfor intubation, and time to bulbar weakness; in the COVID-19 period, independent predictors included time from onset to admission, intubation, and intubation requirement. The mortality rate was 2.3% during the entire study period (13/555 cases). Discussion: Results of this study revealed an overall reduction in the frequency of GBS during the pandemic. The lockdown likely reduced the risk for antecedent infections due to social distancing and improved hygiene, which may have resulted in the reduction of the frequency of GBS.
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- 2022
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3. Approach to the diagnosis of metabolic myopathies
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Madhu Nagappa and Gayathri Narayanappa
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glycogen storage disorders ,lipid storage disorders ,mitochondrial disorders ,Pathology ,RB1-214 ,Microbiology ,QR1-502 - Abstract
Metabolic myopathies are a diverse group of genetic disorders that result in impaired energy production. They are individually rare and several have received the 'orphan disorder' status. However, collectively they constitute a relatively common group of disorders that affect not only the skeletal muscle but also the heart, liver, and brain among others. Mitochondrial disorders, with a frequency of 1/8000 population, are the commonest cause of metabolic myopathies. Three main groups that cause metabolic myopathy are glycogen storage disorders (GSD), fatty acid oxidation defects (FAOD), and mitochondrial myopathies. Clinically, patients present with varied ages at onset and neuromuscular features. While newborns and infants typically present with hypotonia and multisystem involvement chiefly affecting the liver, heart, kidney, and brain, patients with onset later in life present with exercise intolerance with or without progressive muscle weakness and myoglobinuria. In general, GSDs result in high-intensity exercise intolerance while, FAODs, and mitochondrial myopathies predominantly manifest during endurance-type activity, fasting, or metabolically stressful conditions. Evaluation of these patients comprises a meticulous clinical examination and a battery of investigations which includes- exercise stress testing, metabolic and biochemical screening, electrophysiological studies, neuro-imaging, muscle biopsy, and molecular genetics. Accurate and early detection of metabolic myopathies allows timely counseling to prevent metabolic crises and helps in therapeutic interventions. This review summarizes the clinical features, diagnostic tests, pathological features, treatment and presents an algorithm to diagnose these three main groups of disorders.
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- 2022
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4. Recent advances in the diagnosis of immune mediated demyelinating neuropathies
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Shilpa Rao, Madhu Nagappa, and Anita Mahadevan
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demyelinating ,diagnosis ,inflammatory ,nerve biopsy ,neuropathies ,serology ,Pathology ,RB1-214 ,Microbiology ,QR1-502 - Abstract
Inflammatory neuropathies are a group of acquired neuropathies which could be due to autoimmune, infectious, paraneoplastic, or paraproteinemic etiology. The etiological diagnosis of inflammatory neuropathy is not simple, and often requires combination of clinical, electrophysiological, and histopathological findings to arrive at a precise diagnosis which is important for management of the disorder. Whereas there are comprehensive and sensitive panel of serological tests available for diagnosis of the infectious, paraneoplastic, paraproteinemic neuropathies, the diagnosis of immune-mediated demyelinating neuropathies remain a considerable challenge as there is both clinical and pathological overlap. Newer non-invasive methodologies such as high-resolution ultrasound, magnetic resonance imaging (MRI), and importantly, serological testing for antibodies are emerging, and it is essential for the practicing pathologist to be up-to-date with emerging modalities. In this review, we focus on the approach to diagnosis of immune-mediated demyelinating neuropathies.
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- 2022
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5. Impact of the COVID-19 pandemic on the frequency, clinical spectrum and outcomes of pediatric guillain-Barré syndrome in India: A multicentric ambispective cohort study
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Divyani Garg, Rajinder K Dhamija, Aditya Choudhary, Ritu Shree, Sujit Kumar, Priyanka Samal, Abhishek Pathak, Pamidimukkala Vijaya, Yareeda Sireesha, Sruthi S Nair, Sanjay Sharma, Soaham Desai, Human P Sinha, Ayush Agarwal, Ashish Upadhyay, M V Padma Srivastava, Rohit Bhatia, Awadh K Pandit, Rajesh K Singh, Alisha Reyaz, P M Yogeesh, Manish Salunkhe, Vivek Lal, Manish Modi, Gagandeep Singh, Monika Singla, Samhita Panda, Maya Gopalakrishnan, Inder Puri, Sudhir Sharma, Bismay Kumar, Prashant K Kushwaha, Harshadkumar Chovatiya, Teresa Ferreira, Sanjeev K Bhoi, Manish Bhartiya, Subhash Kaul, Anuja Patil, Neeharika L Mathukumalli, Madhu Nagappa, P Praveen Sharma, Aneesh Basheer, Dileep Ramachandran, Neetha Balaram, Jospeh Sebastian, Venugopalan Y Vishnu, and on behalf of the GBS consortium
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aidp ,aman ,covid-19 ,ivig ,guillain–barre syndrome ,sars-cov2 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Objective: To study impact of COVID-19 pandemic on frequency, clinical/electrophysiological profile and treatment outcomes in pediatric Guillain-Barré syndrome (GBS). Background: GBS is the most frequent cause of pediatric acute flaccid paralysis. The effect of the COVID-19 pandemic on pediatric GBS is unclear in the literature. Methods: We conducted an ambispective, multicentric, cohort study involving 12 of 27 centres in GBS Consortium, during two periods: pre-COVID-19 (March-August 2019) and during COVID-19 (March-August 2020). Children ≤12 years who satisfied National Institute of Neurological Diseases and Stroke criteria for GBS/variants were enrolled. Details pertaining to clinical/laboratory parameters, treatment and outcomes (modified Rankin Scale (mRS) at discharge, GBS Disability score at discharge and 3 months) were analysed. Results: We enrolled 33 children in 2019 and 10 in 2020. Children in 2020 were older (median 10.4 [interquartile range 6.75–11.25] years versus 5 (2.5–8.4) years; P = 0.022) and had more sensory symptoms (50% versus 18.2%; P = 0.043). The 2020 group had relatively favourable mRS at discharge (median 1 (1–3.5) versus 3 (2–4); P = 0.042) and GBS disability score at 3 months (median 0 (0–0.75) versus 2 (0–3); P = 0.009) compared to 2019. Multivariate analysis revealed bowel involvement (P = 0.000) and ventilatory support (P = 0.001) as independent predictors of disability. No child in 2020 had preceding/concurrent SARS-CoV2 infection. Conclusions: The COVID-19 pandemic led to a marked decline in pediatric GBS presenting to hospitals. Antecedent illnesses, clinical and electrophysiological profile of GBS remained largely unchanged from the pre-pandemic era.
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- 2022
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6. Diffuse meningeal melanomatosis with congenital facial nevus in an adult
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Lakshminarayanapuram G Viswanathan, Doniparthi V Seshagiri, Shilpa Rao, Venkatachalam Neerupaka, Karthik Kulanthaivelu, Madhu Nagappa, and Sanjib Sinha
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Neurology. Diseases of the nervous system ,RC346-429 - Published
- 2023
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7. Utility of immunohistochemistry and western blot in profiling clinically suspected cases of congenital muscular dystrophy
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Radhika Mhatre, Deepha Sekar, Jessiena Ponmalar, Madhu Nagappa, Preethish-Kumar Veeramani, Kiran Polavarapu, Seena Vengalil, Nalini Atchayaram, and Gayathri Narayanappa
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α-dystroglycan ,cmd ,collagen vi ,ihc ,laminin ,pomt1 ,wb ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Objective: Immunocharacterization of congenital muscular dystrophy (CMD) to determine the frequency of various subtypes in a large Indian Cohort. Materials and Methods: This retrospective (2014-2017) study was carried on muscle biopsies of clinically suspected cases of CMD with histological evidence of dystrophy/myopathic features. Immunohistochemistry (IHC) to antibodies against laminin (α2, α5,β1,γ1), Collagen-VI (A1,2,3), and Western blot (WB) for α-dystroglycan and POMT1 was performed. Results: The study included 57 cases, of which 15 cases (26.3%) had mean age at presentation of 3.5 years, M: F = 1.5:1, elevated creatinine kinase (CK) (mean 1657 U/L), global developmental delay, multiple contractures, abnormal facies, white matter hyperintensities and showed laminin-α2 deficiency (Merosin deficient CMD). In addition, secondary reduction in laminin-β1, over-expression of laminin-α5, and preserved laminin-γ1 was noted. Ullrich CMD constituted 11/57 cases (19.2%) with mean age at presentation of 5.3 years, M: F = 1.2:1 and normal CK. They presented with proximal muscle weakness, soft velvety palms and soles, contractures, and joint hyperextensibility. Collagen-VI (A1,2,3) showed either complete (n = 3) or sarcolemmal specific (n = 8) loss of staining. Out of the remaining 31 cases, WB for α-dystroglycan was performed in 17 cases which showed deficiency in seven (12.3%). Three of these in addition revealed secondary partial loss of laminin-α2. WB for POMT1 showed deficiency in a single case clinically diagnosed Walker–Warburg syndrome, who presented with seizures and classical features of pachygyria, lissencephaly, and cerebellar cyst on MRI. Twenty-four cases (42.2%) remained uncharacterized and need genetic evaluation. Conclusion: The study helped in characterizing 57.8% of the proband. Immunotyping helps to direct mutational analysis for targeted genes and offers a potential route for prenatal diagnosis.
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- 2021
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8. Clinical profile and treatment response in patients with CASPR2 antibody-associated neurological disease
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Sumanth Shivaram, Madhu Nagappa, Doniparthi V Seshagiri, Anita Mahadevan, Yashwanth Gangadhar, T N Sathyaprabha, Vijay Kumavat, Rose D Bharath, Sanjib Sinha, and Arun B Taly
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autoimmune encephalitis ,contactin-associated protein-like 2 (caspr2) ,morvan syndrome ,paraneoplastic neurological disease ,voltage-gated potassium channel ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background: The clinical spectrum of contactin-associated protein-like 2 (CASPR2) antibody-associated disease is wide and includes Morvan syndrome. Studies describing treatment and long-term outcome are limited. Aims: We report the clinical profile and emphasize response to treatment and long-term outcome in eight patients with CASPR2-antibody-associated disease. Methods: Clinical, radiological, electrophysiological, treatment, follow-up, and outcome data were collected by retrospective chart review. Results: Clinical manifestations included Morvan syndrome (n = 7) and limbic encephalitis (n = 1). None of the patients were positive for LGI1 antibody. Associated features included myasthenia (n = 1), thymoma (n = 1), and dermatological manifestations (n = 4). Patients were treated with intravenous methylprednisolone and plasma exchange during the acute symptomatic phase followed by pulsed intravenous methyl prednisolone to maintain remission. Mean-modified Rankin score at admission (pre-treatment), discharge, and last follow-up were 3.75, 2.5, and 0.42, respectively. One patient with underlying thymoma and myasthenic crisis died. The other seven patients were followed up for a mean duration of 19.71 months. All of them improved completely. Relapse occurred in one patient after 13 months but responded favorably to steroids. Conclusion: CASPR2 antibody-associated disease has favorable response to immunotherapy with complete improvement and good outcome. Underlying malignancy may be a marker for poor prognosis.
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- 2021
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9. Spectrum and evolution of EEG changes in Anti-NMDAR encephalitis
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Lakshminarayanapuram Gopal Viswanathan, Shreedhara A Siddappa, Madhu Nagappa, Anita Mahadevan, Shishir Duble, Parayil S Bindu, Arun B Taly, and Sanjib Sinha
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autoimmune encephalitis ,eeg ,nmda receptor encephalitis ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background: NMDA receptor encephalitis (NMDARE) is the most prevalent autoimmune encephalitis and it encompasses a spectrum of clinical features. It is most commonly associated with alteration in consciousness, seizures, neuro-psychiatric symptoms, and movement disorders. Electroencephalography (EEG) plays a vital role and can give clues to diagnosis in a subset of patients. Methods: We retrospectively characterized the clinical and EEG findings in our NMDARE patients (n = 48). A total of 131 EEGs were analyzed. Results: We observed that patients with seizures had a younger age of onset (p < 0.001). The most common EEG pattern that was noted was diffuse slowing (n = 20) followed by generalized rhythmic delta activity (n = 9), focal spikes and slowing (n = 8 each). Delta brush pattern was seen in only 3 EEGs. Focal ictal rhythms were seen in 3 EEGs. There was no significant difference in outcomes such as seizure recurrence, modified Rankin score (mRS) at follow up/discharge or relapse between groups of patients who had EEG abnormalities in the first EEG and with those who did not. Conclusions: NMDARE has varied EEG findings, most of them being non-specific. When combined with clinical presentation, EEG is a useful tool in the diagnosis and management of NMDARE.
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- 2021
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10. Vogt-koyanagi-harada syndrome - A neurologist's perspective
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Sumanth Shivaram, Madhu Nagappa, Doniparthi V Seshagiri, Jayanth Shimoga Shanthakumar, Swayang Sudha Panda, Ravi Anadure, B N Nandeesh, Yasha T Chickabasaviah, Rose D Bharath, Joy Vijayan, Bakula Kashyap, Sanjib Sinha, and Arun B Taly
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aseptic meningitis ,brain-eye-ear (bee) syndromes ,exudative retinal detachment ,melanin-laden macrophages ,poliosis ,vogt-koyanagi-harada syndrome ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Vogt-Koyanagi-Harada (VKH) syndrome is an immune-mediated granulomatous disease which affects melanin-rich organs like eyes, skin, nervous system, and ears. Neurological and auditory manifestations usually precede the involvement of other sites. Patients may manifest with “complete” or “incomplete” syndrome. We report two patients who presented with acute headache and impaired vision. Fundus examination revealed optic disc hyperemia and exudative retinal detachment which provided a clue for the diagnosis at the bedside. Fundus fluorescein angiogram (FFA) revealed abnormal dye leakage, whereas B scan showed choroid thickening. Cerebrospinal fluid (CSF) pleocytosis contrasted with unremarkable brain magnetic resonance imaging and lack of meningeal signs. Melanophagocytosis was evidenced by melanin-laden macrophages in CSF and skin biopsy. This finding is specific for VKH syndrome and helps to clinch the diagnosis even when the complete syndrome is not present cross-sectionally. VKH syndrome should be suspected in patients with aseptic meningitis if tests for common infectious and immune-mediated diseases are negative.
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- 2021
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11. Clinico-pathological features in köhlmeier–degos disease with cutaneous and neurological involvement
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Dodmallur Mallikarjuna Sindhu, Sumanth Shivaram, Shilpa Rao, Madhu Nagappa, Doniparthi V Seshagiri, Vani Santosh, J Madhukara, A S Shreedhara, Maya D Bhat, Rose D Bharath, and Sanjib Sinha
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Neurology. Diseases of the nervous system ,RC346-429 - Published
- 2021
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12. Identification and functional characterization of two novel mutations in KCNJ10 and PI4KB in SeSAME syndrome without electrolyte imbalance
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Ravi K. Nadella, Anirudh Chellappa, Anand G. Subramaniam, Ravi Prabhakar More, Srividya Shetty, Suriya Prakash, Nikhil Ratna, V. P. Vandana, Meera Purushottam, Jitender Saini, Biju Viswanath, P. S. Bindu, Madhu Nagappa, Bhupesh Mehta, Sanjeev Jain, and Ramakrishnan Kannan
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Medicine ,Genetics ,QH426-470 - Abstract
Abstract Background Dysfunction in inwardly rectifying potassium channel Kir4.1 has been implicated in SeSAME syndrome, an autosomal-recessive (AR), rare, multi-systemic disorder. However, not all neurological, intellectual disability, and comorbid phenotypes in SeSAME syndrome can be mechanistically linked solely to Kir4.1 dysfunction. Methods We therefore performed whole-exome sequencing and identified additional genetic risk-elements that might exert causative effects either alone or in concert with Kir4.1 in a family diagnosed with SeSAME syndrome. Results Two variant prioritization pipelines based on AR inheritance and runs of homozygosity (ROH), identified two novel homozygous variants in KCNJ10 and PI4KB and five rare homozygous variants in PVRL4, RORC, FLG2, FCRL1, NIT1 and one common homozygous variant in HSPA6 segregating in all four patients. The novel mutation in KCNJ10 resides in the cytoplasmic domain of Kir4.1, a seat of phosphatidylinositol bisphosphate (PIP2) binding. The mutation altered the subcellular localization and stability of Kir4.1 in patient-specific lymphoblastoid cells (LCLs) compared to parental controls. Barium-sensitive endogenous K+ currents in patient-specific LCLs using whole-cell patch-clamp electrophysiology revealed membrane depolarization and defects in inward K+ ion conductance across the membrane, thereby suggesting a loss-of-function effect of KCNJ10 variant. Conclusion Altogether, our findings implicate the role of new genes in SeSAME syndrome without electrolyte imbalance and thereby speculate the regulation of Kir4.1 channel activity by PIP2 and integrin-mediated adhesion signaling mechanisms.
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- 2019
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13. Lipoid proteinosis (urbach-wiethe disease): A rare genodermatosis with characteristic dermatological and neuroimaging findings
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Aparajita Chatterjee, Lakshminarayanapuram G Viswanathan, Madhu Nagappa, and Sanjib Sinha
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Neurology. Diseases of the nervous system ,RC346-429 - Published
- 2021
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14. Hypereosinophilia as a cause of recurrent stroke
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Srikant Venkatakrishnan, Anupam Gupta, Meeka Khanna, Madhu Nagappa, and Cecil Ross
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Neurology. Diseases of the nervous system ,RC346-429 - Published
- 2020
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15. Genetic analysis of ATP7B in 102 south Indian families with Wilson disease.
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Nivedita Singh, Pradeep Kallollimath, Mohd Hussain Shah, Saketh Kapoor, Vishwanath Kumble Bhat, Lakshminarayanapuram Gopal Viswanathan, Madhu Nagappa, Parayil S Bindu, Arun B Taly, Sanjib Sinha, and Arun Kumar
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Medicine ,Science - Abstract
Wilson disease (WD) is an autosomal recessive disorder, characterized by excessive deposition of copper in various parts of the body, mainly in the liver and brain. It is caused by mutations in ATP7B. We report here the genetic analysis of 102 WD families from a south Indian population. Thirty-six different ATP7B mutations, including 13 novel ones [p.Ala58fs*19, p.Lys74fs*9, p.Gln281*, p.Pro350fs*12, p.Ser481*, p.Leu735Arg, p.Val752Gly, p.Asn812fs*2, p.Val845Ala, p.His889Pro, p.Ile1184fs*1, p.Val1307Glu and p.Ala1339Pro], were identified in 76/102 families. Interestingly, the mutation analysis of affected individuals in two families identified two different homozygous mutations in each family, and thus each affected individual from these families harbored two mutations in each ATP7B allele. Of 36 mutations, 28 were missense, thus making them the most prevalent mutations identified in the present study. Nonsense, insertion and deletion represented 3/36, 2/36 and 3/36 mutations, respectively. The haplotype analysis suggested founder effects for all the 14 recurrent mutations. Our study thus expands the mutational landscape of ATP7B with a total number of 758 mutations. The mutations identified during the present study will facilitate carrier and pre-symptomatic detection, and prenatal genetic diagnosis in affected families.
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- 2019
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16. Vasculitic neuropathy in elderly: A study from a tertiary care university hospital in South India
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Anish Lawrence, Madhu Nagappa, Anita Mahadevan, and Arun B Taly
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Elderly neuropathy ,nerve biopsy ,vasculitic neuropathy ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Objective: To describe clinical, electrophysiological, and histopathological profile of vasculitic neuropathy in elderly subjects aged 65 years or more. Design: Retrospective chart review. Setting: Departments of Neurology and Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India. Patients and Methods: Elderly subjects, diagnosed vasculitic neuropathy by nerve biopsy over one decade, were studied. Results: The cohort consisted of 46 subjects. Symptom duration was 21.54 ± 33.53 months. Onset was chronic in majority (82.6%). Key features included paresthesias (89%), weakness (80%), sensory loss (70%), wasting (63%), and relapsing-remitting course (6.5%). Most Common clinico-electrophysiological patterns were distal symmetrical sensorimotor polyneuropathy - 19, mononeuritis multiplex - 9, and asymmetric sensorimotor neuropathy - 10. Diagnosis of vasculitis was not suspected before biopsy in 31 (67.3%). Nerve biopsy revealed definite vasculitis - 12, probable - 10, and possible - 24. Treatment included immunomodulatory agents (41), symptomatic medications only (9), and antiretroviral therapy (1). Twenty-four patients were followed up for mean period of 6.5 months. Outcome at last follow-up was improved (13), unchanged (8), and worsened (3). Conclusion: Vasculitis is an important, treatable cause of neuropathy in elderly. Nerve biopsy should be used judiciously for early diagnosis and appropriate treatment.
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- 2016
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17. Ictal Generalized EEG Attenuation (IGEA) and hypopnea in a child with occipital type 1 cortical dysplasia - Is it a biomarker for SUDEP?
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Ganne Chaitanya, Santosh N Subbareddy, Jayabal Velmurugan, Arima Arivazhagan, Bharath D Rose, Anita Mahadevan, Madhu Nagappa, Parayil S Bindu, Malla Bhaskara Rao, Arun B Taly, Parthasarathy Satishchandra, and Sanjib Sinha
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Ictal hypopnea ,ictal generalized EEG attenuation ,occipital lobe epilepsy ,status epilepticus ,sudden unexpected death in epilepsy ,SUDEP ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
An interesting association of ictal hypopnea and ictal generalized EEG attenuation (IGEA) as possible marker of sudden unexpected death in epilepsy (SUDEP) is reported. We describe a 5-years-old girl with left focal seizures with secondary generalization due to right occipital cortical dysplasia presenting with ictal hypopnea and IGEA. She had repeated episodes of the ictal apnoea in the past requiring ventilator support and intensive care unit (ICU) admission during episodes of status epilepticus. The IGEA lasted for 0.26-4.68 seconds coinciding with the ictal hypopnea during which both clinical seizure and electrical epileptic activity stopped. Review of literature showed correlation between post-ictal apnoea and post ictal generalized EEG suppression and increased risk for SUDEP. The report adds to the growing body of literature on peri-ictal apnea, about its association with IGEA might be considered as a marker for SUDEP. She is seizure free for 4 months following surgery.
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- 2015
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18. Differential improvement of the sleep quality among patients with juvenile myoclonic epilepsy with valproic acid: A longitudinal sleep questionnaire-based study
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Chetan Nayak, Sanjib Sinha, Chaitra T Ramachandraiah, Madhu Nagappa, Kandivali Thennarasu, Arun B Taly, and Parthasarathy Satishchandra
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Juvenile myoclonic epilepsy ,sleep ,SVA ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Objectives: The aim of this study was to assess the effect of sodium valproic acid (SVA) on the sleep quality of patients with juvenile myoclonic epilepsy (JME). Materials and Methods: Standardized sleep questionnaires viz. Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI) were administered to 30 drug-naïve patients with JME (male:female (M:F) = 14:16; age: 21 ± 3.7 years) and the changes following SVA monotherapy was analyzed using t- and chi-squared tests. Results: The mean age at onset of seizures and diagnosis was 15.43 ± 3.8 and 21 ± 5.1, years respectively. All had myoclonic jerks with mean duration of 5.23 ± 2.7 years, aggravated by sleep deprivation (23, 76.7%) and sleep-wake transition (29, 96.7%). Twenty-seven (90%) had generalized tonic-clonic seizures (GTCS), majority (70%) on awakening from sleep. Seizures were controlled in 25 patients (83.33%) with SVA monotherapy. Abnormal ESS was noted in five (16.66%) drug naοve patients compared to six (20%) patients while on SVA (P = 0.782). Mean ESS remained unchanged before and after SVA therapy (6.27 ± 4.4 vs 6.97 ± 4.7, P = 0.262). On the other hand, only four (13.3%) patients had abnormal PSQI scores at follow-up after initiation of SVA, as compared to 14 (46.7%) subjects in the drug naïve state (P = 0.037). Further, we also found significant reduction in mean PSQI scores after initiating SVA monotherapy (6.7 ± 5.6 vs 2.7 ± 2.84, P ͳ 0.0001). Conclusion: This study showed that the mean PSQI as well as the number of patients with abnormal PSQI significantly reduced after initiating SVA therapy, suggesting a significant improvement in night-time sleep quality with SVA treatment. However, SVA therapy did not alter ESS.
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- 2015
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19. An uncommon cause of bifacial weakness and non-length-dependent demyelinating neuropathy
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Madhu Nagappa, Arun B Taly, Anita Mahadevan, Mailankody Pooja, Parayil Sankaran Bindu, Yasha T Chickabasaviah, Narayanappa Gayathri, and Sanjib Sinha
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Demyelinating neuropathy ,facial weakness ,tangier disease ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Tangier disease is a rare metabolic disorder that causes neuropathy in half of the affected individuals. We present the clinical, electrophysiological, and histopathological findings in a middle-aged gentleman of Tangier disease who was initially diagnosed as leprosy and treated with antileprosy drugs. The presence of a demyelinating electrophysiology in a patient with predominant upper limb involvement and facial diplegia should raise the suspicion of Tangier disease. Estimation of serum lipids should form a part of routine evaluation in order to avoid misdiagnosis.
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- 2015
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20. Tangier′s disease: An uncommon cause of facial weakness and non-length dependent demyelinating neuropathy
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Madhu Nagappa, Arun B Taly, Anita Mahadevan, M Pooja, P S Bindu, Y T Chickabasaviah, N Gayathri, and Sanjib Sinha
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Lipid profile ,neuropathy ,Tangier disease ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Tangier disease is an autosomal recessive disorder characterized by an abnormal accumulation of cholesterol esters in various organs secondary to adenotriphosphate binding cassette transporter A-1 (ABCA-1) transporter deficiency and disrupted reverse cholesterol transport. It causes neuropathy in half of the affected individuals. We present the clinical, electrophysiological, and histopathological findings in a middle aged gentleman of Tangier disease who was initially misdiagnosed leprosy and treated with antileprosy drugs. The presence of a demyelinating neuropathy on electrophysiology in a patient with predominant upper limb involvement and facial diplegia should raise the suspicion of Tangier disease. The characteristic lipid profile of Tangier disease was noted in this patient viz. extremely low high density lipoprotein (HDL), elevated triglyceride (TG), and reduced apolipoprotein A1. Estimation of serum lipids should form a part of routine evaluation in order to avoid misdiagnosis.
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- 2016
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21. Clinical, hematological, and imaging observations in a 25-year-old woman with abetalipoproteinemia
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Madhu Nagappa, Parayil S Bindu, Sikandar Adwani, Sangeeta K Seshagiri, Jitender Saini, Sanjib Sinha, and Arun B Taly
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Abetalipoproteinemia ,acanthocytes ,dorsal column hyperintensity ,magnetic resonance imaging ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Abetalipoproteinemia is an uncommon cause of ataxia and retinitis pigmentosa (RP). Most of the neurological and ocular manifestations occur secondary to deficiency syndromes that is consequent to fat malabsorption from the small intestine. In this report, we have described the phenotype of a young adult female who manifested with recurrent diarrheal illness in her first decade, followed by anemia, RP, and neurological involvement with progressive deafness, cerebellar and sensory ataxia, and subclinical neuropathy in her second decade of life. While RP and sensory ataxia due to vitamin E deficiency are well-recognized features of abetalipoproteinemia, deafness is rarely described. In addition, we have highlighted the abnormal posterior column signal changes in the cervical cord in this patient. Early recognition avoids unnecessary investigations and has a potential to retard the disease progression by replacing some of the deficient vitamins.
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- 2014
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22. Prevalence of fatigue in Guillain-Barre syndrome in neurological rehabilitation setting
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Prajna Ranjani, Meeka Khanna, Anupam Gupta, Madhu Nagappa, Arun B Taly, and Partha Haldar
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Fatigue ,Guillain Barre syndrome ,rehabilitation ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background: Fatigue contributes significantly to the morbidity and affects the quality of life adversely in Guillain-Barre Syndrome (GBS). Objective: To determine the prevalence of fatigue in GBS in neurological rehabilitation setting and to study its clinical correlates. Materials and Methods: We performed secondary analysis of data of patients with GBS admitted in neurological rehabilitation ward of a tertiary care centre, recorded at both admission and discharge. Assessment of fatigue was done by Fatigue Severity Scale (FSS), disability-status by Hughe′s Disability Scale (HDS), functional-status by Barthel Index, anxiety/depression by Hospital Anxiety Depression Scale, sleep disturbances by Pittsburgh Sleep Quality Index and muscle weakness by Medical Research Council sum scores. Results: A total of 90 patients (62 men) with mean age 34 years (95% CI 32.2, 37.7) were included. Median duration of, stay at neurological rehabilitation ward was 30 days, while that of symptoms was 18.5 days. Presence of fatigue at admission (FSS ≥ 4 in 39% patients) was associated with ventilator requirement (P = 0.021) and neuropathic pain (P = 0.03). Presence of fatigue at discharge (FSS ≥ 4 in 12% patients) was associated with disability- HDS (≥3) (P = 0.008), presence of anxiety (P = 0.042) and duration of stay at rehabilitation ward (P = 0.02). Fatigue did not correlate with age, gender, antecedent illness, muscle weakness, depression and sleep disturbances. Conclusion: Fatigue is prevalent in GBS during early recovery phase of illness. Despite motor recovery fatigue may persist. Knowledge about fatigue as burden of disease in these patients will improve patient care.
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- 2014
- Full Text
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23. Genetic Analysis of PLA2G6 in 22 Indian Families with Infantile Neuroaxonal Dystrophy, Atypical Late-Onset Neuroaxonal Dystrophy and Dystonia Parkinsonism Complex.
- Author
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Saketh Kapoor, Mohd Hussain Shah, Nivedita Singh, Mohammad Iqbal Rather, Vishwanath Bhat, Sindhura Gopinath, Parayil Sankaran Bindu, Arun B Taly, Sanjib Sinha, Madhu Nagappa, Rose Dawn Bharath, Anita Mahadevan, Gayathri Narayanappa, Yasha T Chickabasaviah, and Arun Kumar
- Subjects
Medicine ,Science - Abstract
Mutations in PLA2G6 were identified in patients with a spectrum of neurodegenerative conditions, such as infantile neuroaxonal dystrophy (INAD), atypical late-onset neuroaxonal dystrophy (ANAD) and dystonia parkinsonism complex (DPC). However, there is no report on the genetic analysis of families with members affected with INAD, ANAD and DPC from India. Therefore, the main aim of this study was to perform genetic analysis of 22 Indian families with INAD, ANAD and DPC. DNA sequence analysis of the entire coding region of PLA2G6 identified 13 different mutations, including five novel ones (p.Leu224Pro, p.Asp283Asn, p.Arg329Cys, p.Leu491Phe, and p.Arg649His), in 12/22 (54.55%) families with INAD and ANAD. Interestingly, one patient with INAD was homozygous for two different mutations, p.Leu491Phe and p.Ala516Val, and thus harboured four mutant alleles. With these mutations, the total number of mutations in this gene reaches 129. The absence of mutations in 10/22 (45.45%) families suggests that the mutations could be in deep intronic or promoter regions of this gene or these families could have mutations in a yet to be identified gene. The present study increases the mutation landscape of PLA2G6. The present finding will be useful for genetic diagnosis, carrier detection and genetic counselling to families included in this study and other families with similar disease condition.
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- 2016
- Full Text
- View/download PDF
24. Granulomatous Amoebic Meningoencephalitis in an Immunocompromised Patient With AIDS and Neurosyphilis
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Doniparthi Venkata Seshagiri, Lakshminarayanapuram Gopal Viswanathan, Aditi Goyal, Madhu Nagappa, Karthik Kulanthaivelu, Nupur Pruthi, Anita Mahadevan, and Sanjib Sinha
- Subjects
Neurology (clinical) - Published
- 2023
25. Role of altered IL‐33/ST2 immune axis in the immunobiology of Guillain‐Barré syndrome
- Author
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Praveen P. Sharma, Doniparthi V. Seshagiri, Madhu Nagappa, Thrinath Mullapudi, Nikhitha Sreenivas, Saikat Dey, Sumanth Shivaram, Rahul Wahatule, Vijay Kumawat, Binu V. Sreekumaran Nair, Sriganesh Kamath, Sanjib Sinha, Arun B. Taly, and Monojit Debnath
- Subjects
Genotype ,Neurology ,Humans ,Neurology (clinical) ,Guillain-Barre Syndrome ,Interleukin-33 ,Interleukin-1 Receptor-Like 1 Protein ,Polymorphism, Single Nucleotide - Abstract
The IL-33/ST2 immune axis plays crucial roles in infection and immunity. A dysregulated IL-33/ST2 axis can induce autoimmune reaction and inflammatory responses. Guillain-Barré syndrome (GBS) is an acute peripheral neuropathy, mostly caused by post-infection autoimmunity. The role of IL-33/ST2 axis is not known in GBS. This study aimed to explore the role of IL-33/ST2 axis in GBS.Three single nucleotide polymorphisms (SNPs) of Il33 gene (rs16924159, rs7044343, rs1342336) and three SNPs of Il1rl1 gene (rs10192157, rs1041973, rs10206753) coding for suppressor of tumorigenicity 2 (ST2) were genotyped in 179 GBS patients and 186 healthy controls by TaqMan Allelic Discrimination Assay. Plasma levels of IL-33 and sST2 were measured in a subset of GBS patients (n = 80) and healthy controls (n = 80) by ELISA.The frequencies of CC genotype of rs10192157 (p = 0.043) and TT genotype of rs10206753 (p = 0.036) SNPs of Il1rl1 gene differed significantly between GBS patients and healthy controls. Gene-gene interaction between Il33 and Il1rl1 genes also conferred significant risk for GBS. In addition, the plasma sST2 levels were significantly elevated in GBS patients compared to healthy subjects (24,934.31 ± 1.81 pg/ml vs. 12,518.97 ± 1.51 pg/ml, p 0.001). Plasma sST2 levels showed a significant correlation with the disability scores at the peak of neurological deficit in GBS patients.The IL-33/ST2 axis is suggested to influence the immunopathogenesis of GBS. Genetic variants of Il1rl1 gene might serve as a risk determinant of GBS and plasma sST2 levels might emerge as a biomarker of severity of GBS, if replicated further by other studies.
- Published
- 2022
26. Variations within Toll‐like receptor ( <scp>TLR</scp> ) and <scp>TLR</scp> signaling pathway‐related genes and their synergistic effects on the risk of <scp>Guillain‐Barré</scp> syndrome
- Author
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Debprasad Dutta, Madhu Nagappa, Binu V. Sreekumaran Nair, Sumit Kumar Das, Rahul Wahatule, Sanjib Sinha, Ravi Vasanthapuram, Arun B. Taly, and Monojit Debnath
- Subjects
General Neuroscience ,Neurology (clinical) - Published
- 2022
27. Paroxysmal Dystonia in a Child with Enoyl-CoA Hydratase Short-Chain 1 (ECHS1) Mutations
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Akshata Huddar, Periyasamy Govindaraj, Shwetha Chiplunkar, Madhu Nagappa, Arun B Taly, and Bindu Parayil Sankaran
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Pediatrics, Perinatology and Child Health ,Neurology (clinical) - Published
- 2022
28. Leukodystrophy Due to eIF2B Mutations in Adults
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Parayil Sankaran Bindu, Periyasamy Govindaraj, Doniparthi V. Seshagiri, Madhu Nagappa, Sumanth Shivaram, Sanjib Sinha, Arun B Taly, and Jitender Saini
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Pediatrics ,medicine.medical_specialty ,Adult patients ,Autosomal recessive inheritance ,biology ,business.industry ,Parkinsonism ,Leukodystrophy ,Myoclonic Jerk ,Clinical course ,General Medicine ,medicine.disease ,Vanishing white matter disease ,Neurology ,eIF2B ,biology.protein ,Medicine ,Neurology (clinical) ,business - Abstract
Vanishing white matter disease (VWMD) due to eIF2B mutations is a common leukodystrophy characterised by childhood onset, autosomal recessive inheritance, and progressive clinical course with episodic worsening. There are no reports of genetically confirmed adult patients from India. We describe the phenotype of two adults with genetically confirmed VWMD and typical radiological findings. Both had spastic ataxia and cognitive and behavioural disturbances. Other neurological features included myoclonic jerks and parkinsonism. At the last follow-up (duration: 2–9 years), one patient was wheelchair-bound. VWMD is rare in adults but should be suspected based on radiological findings and confirmed by eIF2B mutation.
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- 2021
29. Peripheral nerve sonography, a novel technique for improving the diagnosis of Hansen’s neuropathy
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Lokesh Bathala, Madhu Nagappa, and Leo H. Visser
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Novel technique ,medicine.medical_specialty ,Peripheral nerve ,business.industry ,medicine ,General Earth and Planetary Sciences ,Radiology ,business ,General Environmental Science - Published
- 2021
30. Serum fibroblast growth factor 21 and growth differentiation factor 15: Two sensitive biomarkers in the diagnosis of mitochondrial disorders
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Bindu Parayil Sankaran, Mariyamma Philip, Anita Mahadevan, Akshata Huddar, Periyasamy Govindaraj, Gayathri Narayanappa, Madhu Nagappa, Sekar Deepha, Shwetha Chiplunkar, J.N. Jessiena Ponmalar, Sanjib Sinha, and Arun B. Taly
- Subjects
Adult ,Genetic Markers ,Male ,Growth Differentiation Factor 15 ,Mitochondrial Diseases ,Neuromuscular disease ,FGF21 ,Adolescent ,Mitochondrial disease ,Respiratory chain ,Young Adult ,medicine ,Humans ,Genetic Predisposition to Disease ,Child ,Molecular Biology ,business.industry ,Infant ,Cell Biology ,Middle Aged ,medicine.disease ,Phenotype ,Fibroblast Growth Factors ,Cross-Sectional Studies ,Gene Expression Regulation ,Case-Control Studies ,Child, Preschool ,Immunology ,Molecular Medicine ,Biomarker (medicine) ,Female ,GDF15 ,business ,Hormone - Abstract
Mitochondrial disorders are often difficult to diagnose because of diverse clinical phenotypes. FGF-21 and GDF-15 are metabolic hormones and promising biomarkers for the diagnosis of these disorders. This study has systematically evaluated serum FGF-21 and GDF-15 levels by ELISA in a well-defined cohort of patients with definite mitochondrial disorders (n = 30), neuromuscular disease controls (n = 36) and healthy controls (n = 36) and aimed to ascertain their utility in the diagnosis of mitochondrial disorders. Both serum FGF-21 and GDF-15 were significantly elevated in patients with mitochondrial disorders, especially in those with muscle involvement. The levels were higher in patients with mitochondrial deletions (both single and multiple) and translation disorders compared to respiratory chain subunit or assembly factor defects.
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- 2021
31. Ethylmalonic encephalopathy ETHE1 p. D165H mutation alters the mitochondrial function in human skeletal muscle proteome
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Bindu Parayil Sankaran, Periyasamy Govindaraj, Tripti Khanna, Madhu Nagappa, Arun B Taly, Sekar Deepha, Gajanan Sathe, Akhilesh Pandey, and Narayanappa Gayathri
- Subjects
Adult ,Male ,Proteomics ,0301 basic medicine ,Nucleocytoplasmic Transport Proteins ,Proteome ,Quantitative proteomics ,Down-Regulation ,Muscle Proteins ,Oxidative phosphorylation ,Mitochondrion ,Biology ,Oxidative Phosphorylation ,Mitochondrial Proteins ,03 medical and health sciences ,0302 clinical medicine ,Ethylmalonic encephalopathy ,medicine ,Humans ,Muscle, Skeletal ,Molecular Biology ,Purpura ,Brain Diseases, Metabolic, Inborn ,Skeletal muscle ,Cell Biology ,medicine.disease ,Mitochondria, Muscle ,030104 developmental biology ,medicine.anatomical_structure ,Biochemistry ,Inborn error of metabolism ,Mutation ,Molecular Medicine ,ETHE1 ,030217 neurology & neurosurgery ,Signal Transduction - Abstract
Ethylmalonic encephalopathy (EE) is a rare autosomal recessive inborn error of metabolism. To study the molecular effects of ETHE1 p. D165H mutation, we employed mass spectrometry-based mitochondrial proteome and phosphoproteome profiling in the human skeletal muscle. Eighty-six differentially altered proteins were identified, of which thirty-seven mitochondrial proteins were differentially expressed, and most of the proteins (37%) were down-regulated in the OXPHOS complex-IV. Also, nine phosphopeptides that correspond to eight mitochondrial proteins were significantly affected in EE patient. These altered proteins recognized are involved in several pathways and molecular functions, predominantly in oxidoreductase activity. This is the first study that has integrated proteome and phosphoproteome of skeletal muscle and identified multiple proteins associated in the pathogenesis of EE.
- Published
- 2021
32. Child Neurology: Hereditary Folate Malabsorption
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Periyasamy Govindaraj, Bindu Parayil Sankaran, Madhu Nagappa, Shwetha Chiplunkar, Akshata Huddar, Arun B. Taly, and Sanjib Sinha
- Subjects
medicine.medical_specialty ,Neurology ,Folic Acid Deficiency ,Compound heterozygosity ,Gastroenterology ,Intestinal absorption ,Consanguinity ,Folic Acid ,Serum folate ,Malabsorption Syndromes ,Seizures ,Internal medicine ,medicine ,Humans ,Loss function ,Neurologic Examination ,business.industry ,Infant ,Hereditary folate malabsorption ,medicine.disease ,Magnetic Resonance Imaging ,Treatment Outcome ,medicine.anatomical_structure ,Congenital folate malabsorption ,Microcephaly ,Female ,Neurology (clinical) ,Choroid ,Tomography, X-Ray Computed ,business ,Proton-Coupled Folate Transporter - Abstract
Hereditary folate malabsorption (HFM, congenital folate malabsorption; OMIM#229050) is a rare, potentially treatable autosomal recessive disorder with multisystem involvement.1 It is caused by homozygous or compound heterozygous mutations in SLC46A1 resulting in loss of function of proton-coupled folate transporter (PCFT),2 required for intestinal absorption and transport of folate across choroid plexus.1,2 This leads to the deficiency of folate in serum and CSF, causing hematologic, immunologic, gastrointestinal, and neurologic manifestations.1 Neuroimaging shows intracranial calcification.3 Diagnosis is confirmed by impaired absorption of an oral folate load, low CSF folate concentration (even after correction of the serum folate concentration), or the identification of pathogenic variants in SLC46A1 on molecular genetic testing.1 We describe the clinical, imaging, biochemical, and genetic findings of a patient with HFM.
- Published
- 2021
33. Modulatory effects of vitamin D on <scp>IL</scp> ‐33/ <scp>ST2</scp> immune axis in <scp>Guillain–Barré</scp> syndrome… quo vadis ?
- Author
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Praveen Pallathadka Sharma, Doniparthi V. Seshagiri, Madhu Nagappa, Thrinath Mullapudi, Nikhitha Sreenivas, Saikat Dey, Sumanth Shivaram, Rahul Wahatule, Vijay Kumawat, Binu V. Sreekumaran Nair, Sriganesh Kamath, Sanjib Sinha, Arun B. Taly, and Monojit Debnath
- Subjects
Neurology ,Neurology (clinical) - Published
- 2022
34. Contribution of nuclear and mitochondrial gene mutations in mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome
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Angamuthu K. Meena, Sanjiban Chakrabarty, Sandeep Mallya, Hanumanthapura R. Arivinda, Madhu Nagappa, Kumarasamy Thangaraj, Sekar Deepha, Bindu Parayil Sankaran, Shama Prasada Kabekkodu, Narayanappa Gayathri, Pradyumna Jayaram, Arun B Taly, Periyasamy Govindaraj, J.N. Jessiena Ponmalar, Kapaettu Satyamoorthy, Sanjib Sinha, and Rajan Kumar Jha
- Subjects
0301 basic medicine ,Mitochondrial DNA ,Mitochondrial disease ,CNV ,DGUOK ,medicine.disease_cause ,MELAS syndrome ,DNA, Mitochondrial ,03 medical and health sciences ,0302 clinical medicine ,Mitochondrial Encephalomyopathies ,MELAS Syndrome ,medicine ,Humans ,Exome sequencing ,Genetics ,Mutation ,Original Communication ,mtDNA ,business.industry ,Nuclear genome ,medicine.disease ,Stroke ,Genes, Mitochondrial ,030104 developmental biology ,Neurology ,Lactic acidosis ,MELAS ,Acidosis, Lactic ,MYH7 ,Neurology (clinical) ,business ,Mutations ,030217 neurology & neurosurgery - Abstract
Background Mitochondrial disorders are clinically complex and have highly variable phenotypes among all inherited disorders. Mutations in mitochon drial DNA (mtDNA) and nuclear genome or both have been reported in mitochondrial diseases suggesting common pathophysiological pathways. Considering the clinical heterogeneity of mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) phenotype including focal neurological deficits, it is important to look beyond mitochondrial gene mutation. Methods The clinical, histopathological, biochemical analysis for OXPHOS enzyme activity, and electron microscopic, and neuroimaging analysis was performed to diagnose 11 patients with MELAS syndrome with a multisystem presentation. In addition, whole exome sequencing (WES) and whole mitochondrial genome sequencing were performed to identify nuclear and mitochondrial mutations. Results Analysis of whole mtDNA sequence identified classical pathogenic mutation m.3243A > G in seven out of 11 patients. Exome sequencing identified pathogenic mutation in several nuclear genes associated with mitochondrial encephalopathy, sensorineural hearing loss, diabetes, epilepsy, seizure and cardiomyopathy (POLG, DGUOK, SUCLG2, TRNT1, LOXHD1, KCNQ1, KCNQ2, NEUROD1, MYH7) that may contribute to classical mitochondrial disease phenotype alone or in combination with m.3243A > G mutation. Conclusion Individuals with MELAS exhibit clinical phenotypes with varying degree of severity affecting multiple systems including auditory, visual, cardiovascular, endocrine, and nervous system. This is the first report to show that nuclear genetic factors influence the clinical outcomes/manifestations of MELAS subjects alone or in combination with m.3243A > G mutation.
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- 2021
35. Clinico-pathological and Molecular Spectrum of Mitochondrial Polymerase γ Mutations in a Cohort from India
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Tripti Khanna, Narayanappa Gayathri, Arun B. Taly, Chetan Kashinkunti, Vandana Nunia, Sekar Deepha, Bindu Parayil Sankaran, Shwetha Chiplunkar, Sanjib Sinha, Madhu Nagappa, Kumarasamy Thangaraj, and Periyasamy Govindaraj
- Subjects
0301 basic medicine ,Genetics ,Mitochondrial DNA ,Ataxia ,Muscle biopsy ,medicine.diagnostic_test ,Mitochondrial disease ,General Medicine ,Biology ,medicine.disease ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,Exon ,030104 developmental biology ,0302 clinical medicine ,Mitochondrial myopathy ,medicine ,medicine.symptom ,Age of onset ,Chronic progressive external ophthalmoplegia ,030217 neurology & neurosurgery - Abstract
Polymerase γ catalytic subunit (POLG), a nuclear gene, encodes the enzyme responsible for mitochondrial DNA (mtDNA) replication. POLG mutations are a major cause of inherited mitochondrial diseases. They present with varied phenotypes, age of onset, and severity. Reports on POLG mutations from India are limited. Hence, this study aimed to describe the clinico-pathological and molecular observations of POLG mutations. A total of 446 patients with clinical diagnosis of mitochondrial disorders were sequenced for all exons and intron-exon boundaries of POLG. Of these, 19 (4.26%) patients (M:F: 10:9) had POLG mutations. The age of onset ranged from 5 to 55 years with an overlapping phenotypic spectrum. Ptosis, peripheral neuropathy, seizures, and ataxia were the common neurological features observed. The most common clinical phenotype was chronic progressive external ophthalmoplegia (CPEO) and CPEO plus (n = 14). Muscle biopsy showed characteristic features of mitochondrial myopathy in fourteen patients (14/19) and respiratory chain enzyme deficiency in eleven patients (11/19). Multiple mtDNA deletions were seen in 47.36% (9/19) patients. Eight pathogenic POLG variations including two novel variations (p.G132R and p.V1106A) were identified. The common pathogenic mutation identified was p.L304R, being present in eight patients (42.1%) predominantly in the younger age group followed by p.W748S in four patients (21%). To the best of our knowledge, this is the first extensive study from India, highlights the clinico-pathological and molecular spectrum of POLG mutations.
- Published
- 2021
36. Clinical profile and treatment response in patients with CASPR2 antibody-associated neurological disease
- Author
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Anita Mahadevan, Yashwanth Gangadhar, Talakad N. Sathyaprabha, Arun B Taly, Madhu Nagappa, Rose Dawn Bharath, Doniparthi V. Seshagiri, Sanjib Sinha, Vijay Kumavat, and Sumanth Shivaram
- Subjects
medicine.medical_specialty ,Treatment response ,Thymoma ,medicine.medical_treatment ,Disease ,Malignancy ,Internal medicine ,medicine ,RC346-429 ,morvan syndrome ,Autoimmune encephalitis ,paraneoplastic neurological disease ,voltage-gated potassium channel ,biology ,business.industry ,Limbic encephalitis ,Immunotherapy ,medicine.disease ,autoimmune encephalitis ,contactin-associated protein-like 2 (caspr2) ,biology.protein ,Original Article ,Neurology (clinical) ,Neurology. Diseases of the nervous system ,Antibody ,business - Abstract
Background: The clinical spectrum of contactin-associated protein-like 2 (CASPR2) antibody-associated disease is wide and includes Morvan syndrome. Studies describing treatment and long-term outcome are limited. Aims: We report the clinical profile and emphasize response to treatment and long-term outcome in eight patients with CASPR2-antibody-associated disease. Methods: Clinical, radiological, electrophysiological, treatment, follow-up, and outcome data were collected by retrospective chart review. Results: Clinical manifestations included Morvan syndrome (n = 7) and limbic encephalitis (n = 1). None of the patients were positive for LGI1 antibody. Associated features included myasthenia (n = 1), thymoma (n = 1), and dermatological manifestations (n = 4). Patients were treated with intravenous methylprednisolone and plasma exchange during the acute symptomatic phase followed by pulsed intravenous methyl prednisolone to maintain remission. Mean-modified Rankin score at admission (pre-treatment), discharge, and last follow-up were 3.75, 2.5, and 0.42, respectively. One patient with underlying thymoma and myasthenic crisis died. The other seven patients were followed up for a mean duration of 19.71 months. All of them improved completely. Relapse occurred in one patient after 13 months but responded favorably to steroids. Conclusion: CASPR2 antibody-associated disease has favorable response to immunotherapy with complete improvement and good outcome. Underlying malignancy may be a marker for poor prognosis.
- Published
- 2021
37. Reader Response: An International Perspective on Preceding Infections in Guillain-Barré Syndrome: The IGOS-1000 Cohort
- Author
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Monojit Debnath and Madhu Nagappa
- Subjects
Neurology (clinical) - Published
- 2023
38. TH-251. The Th17 pathway-related gene signatures modulate the risk and severity of Myasthenia gravis (MG)
- Author
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Nibu Varghese, Nikhitha Sreenivas, Sumanth Shivaram, Thrinath Mullapudi, Doniparthi V Seshagiri, Binu V Sreekumaran Nair, Monojith Debnath, and Madhu Nagappa
- Subjects
Neurology ,Physiology (medical) ,Neurology (clinical) ,Sensory Systems - Published
- 2022
39. Genetic Spectrum of Inherited Neuropathies in India
- Author
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Madhu Nagappa, Shivani Sharma, Periyasamy Govindaraj, YashaT Chickabasaviah, Ramesh Siram, Akhilesh Shroti, DoniparthiV Seshagiri, Monojit Debnath, ParayilS Bindu, and ArunB Taly
- Subjects
Neurology (clinical) - Abstract
Charcot-Marie-Tooth (CMT) disease is the commonest inherited neuromuscular disorder and has heterogeneous manifestations. Data regarding genetic basis of CMT from India is limited. This study aims to report the variations by using high throughput sequencing in Indian CMT cohort.Fifty-five probands (M:F 29:26) with suspected inherited neuropathy underwent genetic testing (whole exome: 31, clinical exome: 17 and targeted panel: 7). Their clinical and genetic data were analysed.Age at onset ranged from infancy to 54 years. Clinical features included early-onset neuropathy (In this single centre cohort study from India, genetic diagnosis could be established in 87% of patients with inherited neuropathy. The identified spectrum of genetic variations adds to the pool of existing data and provides a platform for validation studies in cell culture or animal model systems.
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- 2022
40. Efficacy of pulse intravenous methylprednisolone in epileptic encephalopathy: a randomised controlled trial
- Author
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Anush Rangarajan, Ravindranadh Chowdary Mundlamuri, Raghavendra Kenchaiah, Parthipulli Vasuki Prathyusha, Lakshminarayanapuram Gopal Viswanathan, Ajay Asranna, Aparajita Chatterjee, Madhu Nagappa, Doniparthi Venkata Seshagiri, Karthik Kulanthaivelu, Rose Dawn Bharath, Saini Jitender, Kandavel Thennarasu, and Sanjib Sinha
- Subjects
Psychiatry and Mental health ,Brain Diseases ,Treatment Outcome ,Seizures ,Humans ,Surgery ,Administration, Intravenous ,Neurology (clinical) ,Child ,Methylprednisolone - Abstract
BackgroundHigh-level evidence for using steroids in epileptic encephalopathy (EE), other than West syndrome (WS), is lacking. This study investigated the efficacy and safety of pulse intravenous methylprednisolone (IVMP) in EE other than WS.MethodsThis is an open-label evaluator-blinded randomised controlled study. Children aged 6 months or more with EE other than WS were included. Eighty children were randomised into intervention and non-intervention groups with 40 in each group. At the first visit (T1) seizure frequency, electroencephalographic (EEG) and Vineland Social Maturity Scale (VSMS) were obtained, and antiseizure medication (ASM) were optimised. After 1 month (T2), subjects were randomised to intervention (ASM+3 months IVMP pulse) or non-intervention group (only ASM) with 40 subjects in each group. They were followed up for 4 months (T3) and assessed.ResultsAfter 4 months of follow-up, 75% of patients receiving IVMP had >50% seizure reduction versus 15.4% in control group (χ2=28.29, pDiscussionThree-month pulse IVMP therapy showed significant improvement in seizure frequency, EEG parameters and VSMS scores, with no steroid-related serious adverse effects. It can be considered as a safe and effective add on treatment in children with EE other than WS.Trial registration numberCTRI/2019/02/017807.
- Published
- 2022
41. Impact of Antecedent Infections on the Antibodies against Gangliosides and Ganglioside Complexes in Guillain-Barré Syndrome: A Correlative Study
- Author
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Madhu Nagappa, Debprasad Dutta, Monojit Debnath, DoniparthiV Seshagiri, BinuV Sreekumaran Nair, SumitK Das, Rahul Wahatule, Sanjib Sinha, Vasanthapuram Ravi, and ArunB Taly
- Subjects
Neurology (clinical) - Abstract
Guillain-Barré Syndrome (GBS), an immune-mediated neuropathy, is characterized by antibodies against gangliosides/ganglioside complexes (GSCs) of peripheral nerves. Antecedent infections have been reported to induce antibodies that cross-react with the host gangliosides and thereby have a pivotal role in conferring an increased risk for developing GBS. Data pertaining to the impact of various antecedent infections, particularly those prevalent in tropical countries like India on the ganglioside/GSC antibodies is sparse. We aimed at exploring the association between six antecedent infections and the profile of ganglioside/GSC antibodies in GBS.Patients with GBS (n = 150) and healthy controls (n = 50) were examined for the serum profile of antibodies against GM1, GM2, GD1a, GD1b, GT1b, and GQ1b and their GSCs by ELISA. These antibodies were correlated with immunoreactivities againstThe frequencies of antibodies against six single gangliosides (This study for the first time shows an association between antecedent JE infection and ganglioside antibodies in GBS. This finding reinforces the determining role of antecedent infections on ganglioside antibody responses and the subsequent immunological processes in GBS.
- Published
- 2022
42. Infantile Onset Encephalomyopathy, Heart Block, and Sensorineural Hearing Loss: RMND1-Associated Mitochondrial Disease
- Author
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Arun B. Taly, Madhu Nagappa, Sanjib Sinha, V.P. Vandana, Bindu Parayil Sankaran, Narayanappa Gayathri, J.N. Jessiena Ponmalar, Shwetha Chiplunkar, and Periyasamy Govindaraj
- Subjects
0301 basic medicine ,Muscle biopsy ,medicine.diagnostic_test ,business.industry ,Heart block ,Mitochondrial disease ,Physiology ,030105 genetics & heredity ,medicine.disease ,Hypotonia ,Stop codon ,03 medical and health sciences ,0302 clinical medicine ,Pediatrics, Perinatology and Child Health ,Failure to thrive ,medicine ,Sensorineural hearing loss ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Exome sequencing - Abstract
Mutations in RMND1 (required for mitotic division-1) has been associated with infantile onset mitochondrial disease and combined oxidation phosphorylation deficiency. This report describes a girl child of Indian origin with RMND1-associated mitochondrial disease. This 13-month-old girl, born to consanguineous parents presented with gradual loss of acquired milestones and recurrent vomiting from 5 months of age. She experienced failure to thrive, profound hypotonia, areflexia, and sensorineural deafness. Evaluation showed elevated serum lactate and complete heart block. Audiological evaluation done at 6 and 13 months of age revealed bilateral A type tympanogram, bilateral absent stapedial reflexes, absent otoacoustic emissions (OAE), and absent brainstem auditory evoked responses suggestive of bilateral profound sensorineural hearing loss. Muscle biopsy revealed evidence of ragged red fibers, ragged blue fibers, and Cytochrome coxidase (COX) deficient fibers on histochemistry and multiple complex deficiency on spectrophotometry. Exome sequencing revealed homozygous stop-loss variation, c.1349G > C, in exon 12 of RMDN1 resulting in substitution of amino acid serine for stop codon at position 450 and subsequent elongation of the protein by 31 amino acids (p.Ter450SerextTer31) which was verified by Sanger's sequencing. This report further strengthens the phenotype genotype correlations in RMND1-associated mitochondrial disease, especially the occurrence of the reported variation in South Asian patients. In addition, familiarity with the phenotype might help the physician to do targeted metabolic testing and facilitate appropriate early interventions.
- Published
- 2020
43. Evidence of altered Th17 pathway signatures in the cerebrospinal fluid of patients with Guillain Barré Syndrome
- Author
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Madhu Nagappa, Manjula Subbanna, Malathi Anil Kumar, Parayil Sankaran Bindu, Arun B Taly, Venkataram Shivakumar, Pinku Mani Talukdar, Rahul Wahatule, Sundar Periyavan, G.S. Umamaheswara Rao, Debprasad Dutta, Sanjib Sinha, and Monojit Debnath
- Subjects
Adult ,Male ,medicine.medical_treatment ,Inflammation ,Guillain-Barre Syndrome ,medicine.disease_cause ,Autoimmunity ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,Cerebrospinal fluid ,Physiology (medical) ,Humans ,Medicine ,Prospective Studies ,Prospective cohort study ,Guillain-Barre syndrome ,Interleukin-6 ,business.industry ,Interleukins ,Interleukin-17 ,General Medicine ,Middle Aged ,medicine.disease ,Pathophysiology ,Cytokine ,Neurology ,030220 oncology & carcinogenesis ,Immunology ,Cytokines ,Th17 Cells ,Female ,Surgery ,Neurology (clinical) ,medicine.symptom ,business ,Biomarkers ,030217 neurology & neurosurgery ,Signal Transduction - Abstract
Data indexing the contribution of various immuno-inflammatory components in the cerebrospinal fluid (CSF) towards the pathophysiology of Guillain Barre Syndrome (GBS) are limited. Th17 pathway plays crucial role in many immune mediated disorders of the nervous system. This study was aimed at exploring the role of Th17 pathway related cytokines in the CSF of patients with GBS. Levels of multiple key cytokines of Th17 pathway in CSF of patients with GBS (N = 37) and controls (N = 37) were examined in this prospective study using Bio-plex Pro Human Th17 cytokine assays in a Multiplex Suspension Array platform. The findings were correlated with clinical features and electrophysiological subtypes. Three key cytokines of Th17 pathway (IL-6, IL-17A and IL-22) were significantly elevated in CSF of patients with GBS as compared to controls. There was a positive correlation between the levels of IL-6 and IL-17A as well as between the levels of IL-17A and IL-22 in the CSF of patients with GBS. The CSF levels of IL-6 and IL-22 were negatively correlated with the duration of symptoms of GBS. None of the studied cytokines correlated with functional disability scores at admission to hospital or with the electrophysiological subtypes. Identification of Th17 pathway signatures in CSF sheds more insights into the pathogenic role of Th17 cells in GBS. These findings complement the contemporary knowledge and tender further support towards the involvement of Th17 pathway in GBS.
- Published
- 2020
44. Leukodystrophies and Genetic Leukoencephalopathies in Children Specified by Exome Sequencing in an Expanded Gene Panel
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Sanjib Sinha, Arun B. Taly, Shwetha Chiplunkar, Sonam Kothari, Periyasamy Govindaraj, Madhu Nagappa, and Bindu Parayil Sankaran
- Subjects
0301 basic medicine ,Bioinformatics ,Leukoencephalopathy ,03 medical and health sciences ,0302 clinical medicine ,Neuroimaging ,Leukoencephalopathies ,Exome Sequencing ,Biopsy ,Humans ,Medicine ,Exome ,Gene ,Exome sequencing ,medicine.diagnostic_test ,business.industry ,Leukodystrophy ,Neurodegenerative Diseases ,medicine.disease ,Magnetic Resonance Imaging ,Lysosomal Storage Diseases ,030104 developmental biology ,Pediatrics, Perinatology and Child Health ,Cohort ,Etiology ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Demyelinating Diseases - Abstract
The overlapping clinical and neuroimaging phenotypes of leukodystrophies pose a diagnostic challenge to both clinicians and researchers alike. Studies on the application of exome sequencing in the diagnosis of leukodystrophies are emerging. We used targeted gene panel sequencing of 6440 genes to investigate the genetic etiology in a cohort of 50 children with neuroimaging diagnosis of leukodystrophy/genetic leukoencephalopathy of unknown etiology. These 50 patients without a definite biochemical or genetic diagnosis were derived from a cohort of 88 patients seen during a 2.5-year period (2015 January-2017 June). Patients who had diagnosis by biochemical or biopsy confirmation (n = 17) and patients with incomplete data or lack of follow-up (n = 21) were excluded. Exome sequencing identified variants in 30 (60%) patients, which included pathogenic or likely pathogenic variants in 28 and variants of unknown significance in 2. Among the patients with pathogenic or likely pathogenic variants, classic leukodystrophies constituted 13 (26%) and genetic leukoencephalopathies 15 (30%). The clinical and magnetic resonance imaging (MRI) findings and genetic features of the identified disorders are discussed.
- Published
- 2020
45. Leukodystrophy Due to
- Author
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Sumanth, Shivaram, Madhu, Nagappa, Doniparthi Venkata, Seshagiri, Jitender, Saini, Periyasamy, Govindaraj, Sanjib, Sinha, Parayil Sankaran, Bindu, and Arun B, Taly
- Subjects
Eukaryotic Initiation Factor-2B ,Phenotype ,Leukoencephalopathies ,Mutation ,Humans ,Neurodegenerative Diseases ,Demyelinating Diseases - Abstract
Vanishing white matter disease (VWMD) due to
- Published
- 2021
46. Disorders of Tetrahydrobiopterin Metabolism: Experience from South India
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Debjyoti Dhar, Pooja Mailankody, Madhu Nagappa, Somdattaa Ray, Rammurthy Anjanappa, Pavagada S. Mathuranath, Gautham Arunachal, Mahesh Kamate, Shruthy Sreedharan, Hansashree Padmanabha, Rita Christopher, Maya Bhat, Vykuntaraju K Gowda, Rohan Mahale, and Sadanandavalli Retnaswami Chandra
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Male ,medicine.medical_specialty ,business.industry ,Phenylalanine ,Infant ,Tetrahydrobiopterin metabolism ,Biochemistry ,Biopterin ,Cellular and Molecular Neuroscience ,Dystonia ,Endocrinology ,Internal medicine ,Child, Preschool ,Phenylketonurias ,medicine ,Humans ,Female ,Neurology (clinical) ,business ,Child - Abstract
Background: Disorders of tetrahydrobiopterin metabolism represent a rare group of inherited neurotransmitter disorders which manifest mainly in infancy or childhood with developmental delay, neuroregression, epilepsy, movement disorders and autonomic symptoms. Methodology: A retrospective review of genetically confirmed cases of disorders of tetrahydrobiopterin metabolism over a period of three years (Jan 2018 to Jan 2021) was performed across two paediatric neurology centres from South India.Results: A total of nine patients(M:F=4:5) fulfilled the eligibility criteria. The genetic variants detected include homozygous mutations in the QDPR(n=6), GCH1(n=2) and PTS(n=1) genes. The median age at onset of symptoms was 6-months(range 3-78 months), while that at diagnosis was 15-months (8-120 months) resulting in a median delay in diagnosis of 9-months. The main clinical manifestations included neuroregression (89%), developmental delay(78%), dystonia(78%) and seizures(55%). Management strategies included phenylalanine restricted diet, levodopa/carbidopa, 5-Hydroxytryphtophan, and folinic acid. Only, Patient-2 afforded and received BH4 supplementation at a sub-optimal dose later in the disease course. We had a median duration of follow up of 15 months (range 2-48 months). Though biochemical response has been marked, except for patients with GTPCH deficiency, only mild clinical improvement was noted with regards to developmental milestones, seizures or dystonia in others. Conclusion: Tetrahydrobiopterin deficiencies represent an rare yet potentially treatable cause for non-phenylketonuria hyperphenylalaninemia when diagnosed and treated early in life. Screening for disorders of biopterin metabolism in patients with hyperphenylalaninemia prevents delayed diagnosis. This study expands the genotype phenotype spectrum of patients with disorders of tetrahydrobiopterin metabolism from South India.
- Published
- 2021
47. TH-268. Thermal detection thresholds in Guillain-Barré Syndrome: Does the day of illness matter?
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Srinath Rajeevan, Vamsi Chalasani, Lakshminarayanapuram G. Viswanathan, Doniparthi V. Seshagiri, and Madhu Nagappa
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Neurology ,Physiology (medical) ,Neurology (clinical) ,Sensory Systems - Published
- 2022
48. Antecedent infections in Guillain-Barré syndrome patients from south India
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Vasanthapuram Ravi, Sanjib Sinha, Madhu Nagappa, Monojit Debnath, Debprasad Dutta, Rahul Wahatule, Arun B Taly, and Sumit Kumar Das
- Subjects
medicine.medical_specialty ,medicine.disease_cause ,Guillain-Barre Syndrome ,Campylobacter jejuni ,Gastroenterology ,Virus ,Dengue fever ,Dengue ,Internal medicine ,medicine ,Humans ,Chikungunya ,biology ,Guillain-Barre syndrome ,business.industry ,General Neuroscience ,Japanese encephalitis ,bacterial infections and mycoses ,medicine.disease ,biology.organism_classification ,Peripheral neuropathy ,Immunoglobulin M ,Case-Control Studies ,Etiology ,Chikungunya Fever ,Neurology (clinical) ,business - Abstract
Guillain-Barre syndrome (GBS) is the commonest post-infectious inflammatory peripheral neuropathy with undiscerned aetiology. The commonly reported antecedent infections implicated in India include Campylobacter jejuni, chikungunya, dengue, and Japanese encephalitis (JE). In this study from south India, we investigated the role of these four agents in triggering GBS. This case-control study was performed on 150 treatment-naive patients with GBS and 150 age and sex-matched controls from the same community. IgM immunoreactivity for C. jejuni, chikungunya, and dengue was detected by enzyme-linked immunosorbent assay (ELISA) in serum of patients with GBS and control subjects. Immunoreactivity against JE was detected in serum as well as cerebrospinal fluid (CSF) from patients (n = 150) and orthopaedic control (n = 45) subjects. The immunoreactivity against infections was compared between demyelinating and axonal subtypes of GBS. Overall, 119/150 patients with GBS had serological evidence of antecedent infection. Amongst those with evidence of antecedent infection, 24 (16%), 8 (5%), and 9 (6%) patients were exclusively immunoreactive to chikungunya, JE, and C. jejuni, respectively. In the remaining patients (78/119), immunoreactivity to multiple pathogens was noted. Immunoreactivity to C. jejuni infection was found in 32% of GBS patients compared to 2.7% controls (P
- Published
- 2021
49. Novel Mutation in the POLR1C Gene Causing Hypomyelinating Leukodystrophy in an Adult
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Nishtha Yadav, Madhu Nagappa, and Jitender Saini
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Pediatrics ,medicine.medical_specialty ,Ataxia ,medicine.diagnostic_test ,business.industry ,Tall Stature ,Case ,Physical examination ,medicine.disease ,Hypomyelinating leukodystrophy ,Hypodontia ,Dysmetria ,Medicine ,Neurology (clinical) ,medicine.symptom ,business ,human activities ,Novel mutation ,Consanguineous Marriage - Abstract
We report a case of a 35-year-old male who presented with progressive difficulty in walking with frequent tripping, falling after buckling of knees, difficulty in climbing stairs and swaying while walking for the past 6 months. History was significant for features of subnormal intelligence since childhood and poor scholastic performance. The patient also exhibited behavioral disturbances in the form of aggressive behavior, anger outbursts, excessive talking, and talking to self. The patient was born of a consanguineous marriage. On physical examination, he had tall stature and large ears with no clinical evidence of hypogonadism. No evidence of hypodontia was noted. Neurologic examination revealed cerebellar signs such as ataxia, dysmetria and intention tremors. Pyramidal signs were prominent in lower limbs. Cognitive impairment was also noted.
- Published
- 2021
50. Ganglioside complex antibodies in an Indian cohort of Guillain‐Barré syndrome
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Pandarisamy Sundaravadivel, Arun B Taly, Madhu Nagappa, Shivaji Rao, Monojit Debnath, Anita Mahadevan, Rahul Wahatule, Sanjib Sinha, V S Binu, Debprasad Dutta, Sundar Periyavan, and G.S. Umamaheswara Rao
- Subjects
0301 basic medicine ,Male ,Time Factors ,Physiology ,medicine.medical_treatment ,G(M2) Ganglioside ,030105 genetics & heredity ,Cohort Studies ,0302 clinical medicine ,Gangliosides ,Medicine ,biology ,Guillain-Barre syndrome ,Immunoglobulins, Intravenous ,Plasmapheresis ,Middle Aged ,Pathophysiology ,Treatment Outcome ,Cohort ,Female ,Antibody ,Adult ,endocrine system ,medicine.medical_specialty ,Adolescent ,India ,Enzyme-Linked Immunosorbent Assay ,G(M1) Ganglioside ,Guillain-Barre Syndrome ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,Young Adult ,Physiology (medical) ,Internal medicine ,Hospital discharge ,Humans ,Immunologic Factors ,Autoantibodies ,Mechanical ventilation ,Ganglioside ,business.industry ,fungi ,Gender distribution ,medicine.disease ,Respiration, Artificial ,Case-Control Studies ,biology.protein ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background Antibodies against ganglioside complexes (GSCs) are associated with various clinical features and subtypes of Guillain-Barre syndrome (GBS). Methods One-hundred patients were evaluated for antibodies to GSCs formed by combination of GM1, GM2, GD1a, GD1b, GT1b, and GQ1b using manual enzyme linked immuno-sorbent assay (ELISA). Results Twenty-six patients were GSC antibody-positive, most frequent being against GM1-containing GSC (76.9%). Gender distribution, mean age, symptom-duration, antecedent events, electrophysiological subtypes, requirement for mechanical ventilation, and median duration of hospital stay were comparable between the GSC antibody-positive and negative groups. There was no association between specific GSC antibody and electrophysiological subtypes or clinical variants. After controlling for false discovery rate (FDR) using the Benjamini-Hochberg method, the number of subjects who improved in overall disability sum score, modified Erasmus GBS outcome score, and neuropathy symptom score at discharge was significantly higher in the GSC antibody-positive group. Improvements in Medical Research Council sum scores and Hughes Disability Scale during the hospital stay between the GSC antibody-positive and negative groups were not significantly different after controlling for FDR. Conclusions The GSC antibody-positive group had better outcome at hospital discharge in some of the disability scores. Pathophysiological pathways among patients without GSC antibodies may be different and this requires further evaluation.
- Published
- 2019
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