Search

Aim: As an initial step to develop guidelines for epilepsy monitoring units (EMUs) appropriate for developing countries, we inquired the existing practices in EMUs in India.Methods: After checking for the content and face validity as well for clarity, we sent a 52-item online non-anonymized questionnaire to all the 52 EMUs in India.Results: The questionnaire was completed by 51 of the 52 EMUs (98% response rate). The majority of the EMUs are located in major cities and 51% are located in non-governmental corporate hospitals. There are total of 122 prolonged video-EEG monitoring (PVEM) beds in India and 70% EMUs have ≤2 beds. Approximately two-thirds of the EMUs have defined protocols for pre-procedure consent and risk assessment, management of seizure clusters and status epilepticus, continuous observation of patients, and peri‑ictal testing. Only one-third of the EMUs have protocols for management of post-ictal psychosis, anti-suffocation pillows, and protected environment within bathrooms. The waiting period for PVEM is more (49.9 ± 101 vs. 4.9 ± 10.9 days; p = 0.04) and mean cost for 3-day PVEM is less (INR 8311 ± 9021 vs. 30,371 ± 17,563; p <0.0001) in public as compared to private hospitals. There was a negative correlation between cost of PVEM and the waiting period (r=-0.386; p = 0.01). Safety practices are similar in public and private hospitals.Conclusions: Although practices in EMUs in India vary widely, they are comparable to those in developed countries. India has severe shortage of EMUs and long waiting lists for affordable PVEM. [ABSTRACT FROM AUTHOR]

Anxiety is a cognitive, behavioural, and biological response that prepares the individual to handle the stresses and conflicts of everyday life. The excessive appearance of this biological response is diagnosed as an anxiety disorder, which is often associated with Autonomic dysfunction (ADy). ADy is difficult to study in clinics with very few parameters available. Detection of ADy may not be possible/difficult in anxiety disorder with the existing method. In this study, we built machine learning models to identify ADy in subjects with anxiety using properties extracted from ECG and respiratory signals. For each dataset, statistical and frequency domain features were estimated from ECG and respiratory signals. Supervised machine learning (ML) algorithms were used to classify the subjects. Out of 23 features estimated, 11 were found to be statistically significant for the classification. We segmented the signals into 5, 10, and 30 minutes intervals to build generalized models. To overcome data imbalance, ensemble techniques like boosting was used. The highest accuracy was obtained in the SVM, Random Forest and Gradient Boosting classifiers (cross-validation accuracy of 82.2%, 81.64% and 79.06% and; AUC of 0.81, 0.76 and 0.84) for 10 and 30 minutes segmented datasets. Our results showed that the features extracted from the ECG signal are a good marker for diagnosing ADy in patients with anxiety disorder. Further, a deep neural network-based model can be implemented that may achieve better accuracy for classification provided with the cost of a large number of datasets and computation time. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of ongoing COVID-19 pandemic on epilepsy care in India.Methods: We conducted a three-part survey comprising neurologists, people with epilepsy (PWE), and 11 specialized epilepsy centers across India. We sent two separate online survey questionnaires to Indian neurologists and PWE to assess the epilepsy practice, seizures control, and access to care during the COVID-19 pandemic. We collected and compared the data concerning the number of PWE cared for and epilepsy procedures performed during the 6 months periods preceding and following COVID-19 lockdown from epilepsy centers.Results: The survey was completed by 453 neurologists and 325 PWE. One third of the neurologist reported >50 % decline in outdoor visits by PWE and EEG recordings. The cumulative data from 11 centers showed 65-70 % decline in the number of outdoor patients, video-EEG monitoring, and epilepsy surgery. Working in a hospital admitting COVID-19 patients and use of teleconsultation correlated with this decline. Half of PWE had postponed their planned outpatient visits and EEG. Less than 10 % of PWE missed their antiseizure medicines (ASM) or had seizures due to the nonavailability of ASM. Seizure control remained unchanged or improved in 92 % PWE. Half of the neurologists started using teleconsultation during the pandemic. Only 4% of PWE were afflicted with COVID-19 infection.Conclusions: Despite significant decline in the number of PWE visiting hospitals, their seizure control and access to ASMs were not affected during the COVID-19 pandemic in India. Risk of COVID-19 infection in PWE is similar to general population. [ABSTRACT FROM AUTHOR]

• Albumin Index is used to define blood-brain barrier impairment. • CSF indices allow for assessing intrathecal antibody production. • The major finding is an association of intrathecal IgG synthesis with a better prognosis. • Elevated Albumin Index correlated with poor Glasgow Coma Scale score. • Longer time to initiating immunotherapy is associated with poorer treatment outcomes. Cerebrospinal fluid (CSF) indices reflecting intrathecal antibody production and blood-brain barrier impairment are not routinely assessed in patients with autoimmune encephalitis (AE). We aimed to study CSF indices and their association with the prognosis of AE. This retrospective cohort study conducted at Amrita Institute of Medical Sciences (AIMS), Kochi, India, included 60 patients aged more than 18 years with definite/probable/possible AE admitted to the Department of Neurology from August 2016 to November 2021. We introduced a classification of treatment response based on modified Rankin Scale change over time and treatment modalities. In our cohort of 60 patients (six [10%] seropositive cases), a good rapid treatment response was associated with CSF white blood cell count of more than 4 cells/mm3 (OR, 4.57; 95% CI 1.31–15.96; P =.02) and positive immunoglobulin G (IgG) Local Synthesis (OR, 7.27; 95% CI 1.56–33.86; P =.01). Albumin Index had association with a poor Glasgow Coma Scale score at the nadir of the disease (OR, 1.17; 95% CI 1.01–1.34; P =.04). Similar results were yielded in the seronegative cohort. IgG Local Synthesis appeared to be a strong predictor for good rapid treatment response in both univariate and multivariate (adjusted OR, 28.71; 95% CI 2.12–389.22; P =.01) analysis. Time to immunotherapy was reversely correlated with good response overall (in the cohort with outliers removed [ N = 49]: unadjusted OR 0.97, 95% CI 0.95–0.99; P =.01; adjusted OR 0.97; 95% CI 0.95–0.99; P =.008). CSF indices reflecting intrathecal antibody production and blood-brain barrier impairment appear to be promising predictors of disease severity and therapeutic response in patients with autoimmune encephalitis. [ABSTRACT FROM AUTHOR]

Objectives: We present a case series of patients who underwent perirolandic resection for medically refractory focal epilepsy due to focal cortical dysplasia (FCD). Our aim was to specifically evaluate the outcome of a surgical strategy intended for seizure freedom while preserving primary motor cortex function.Materials and Methods: Thirteen patients undergoing perirolandic resection for pharmacoresistant focal epilepsy between 2010 and 2015 who demonstrated histological evidence of FCD were selected from a prospectively maintained database. Presurgical evaluation included video EEG telemetry and 3T MRI brain for all patients. Eight patients underwent interictal FDG PET scan. Intracranial EEG monitoring was done for 8 patients - six by conventional subdural grid and depth electrodes and two by Stereo EEG. Additional techniques included extraoperative cortical stimulation mapping, intraoperative electrocorticography (ECoG), intraoperative motor cortex mapping and awake surgery in various combinations. In all cases (lesional and nonlesional), resection was intentionally limited for anatomic preservation of the primary motor cortex.Results: Amongst the thirteen patients with age ranging 14-44 years (mean 26.8 ± 9.2) 62% of them had daily seizures. MRI abnormalities were identified in 8 patients (62%), PET showed concordant findings in 7 patients (88%). When utilized, the mean duration of intracranial EEG recordings was 8.0 ± 7.2 days (range 2-23 days). All patients underwent a primary motor cortex-sparing resection of the suspected epileptogenic cortex. The mean postoperative follow up period was 23 months (range 7.5-62 months). Twelve out of 13 (92%) were seizure free (Engel 1) outcome at the last follow-up assessment; one patient had Engel 2a outcome at 28 months. Six patients (46%) had immediate new focal neurological deficits, however all six patients had recovered completely within three months.Conclusion: The surgical strategy of a primary motor cortex-sparing resective surgery for perirolandic FCD is associated with an excellent early seizure-freedom rate and no permanent neurological deficits. Since the ultimate goal of resective epilepsy surgery is seizure freedom with simultaneous functional preservation, similar long term outcome studies should ultimately guide the resection strategy. [ABSTRACT FROM AUTHOR]