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Byline: Prakash. Tandon 'In many general surgical works today the diagnosis of primary brain stem injury amounts to pronouncement of death sentence' (Kalyanaraman and Ramamurthi 1969) It is interesting that [...]

Byline: Krishnan. Ganapathy This review article highlights the necessity and importance of peer review of articles submitted to journals. Publication in a peer reviewed, good impact indexed journal is an [...]

Introduction of international consensus criteria (2015 IPND criteria) for neuromyelitis optica spectrum disorders (NMOSDs) has improved diagnostic accuracy for aquaporin 4 (AQP4)-IgG-associated and seronegative NMOSDs. This study aimed to review relevant publications related to the incidence and prevalence of NMOSDs and provide an updated review of the global epidemiology of NMOSDs in the light of new diagnostic criteria. A comprehensive literature search was performed from January 2015 to June 2021 by using appropriate keywords in PubMed, Scopus, and Web of Science. Relevant papers that fulfilled inclusion criteria were shortlisted and reviewed. Twenty-one papers were selected for this review. Incidence of NMOSDs was 0.04-0.25/100,000 in predominantly white and 0.34-1.31/100,000 in nonwhite populations. Prevalence was 0.70-1.91/100,000 in white and 0.86-4.52/100,000 in nonwhite populations. The 2015 IPND criteria significantly improved the incidence and prevalence rates for NMOSDs when compared to the Wingerchuk 2006 criteria. Incidence of MOG-IgG-associated NMOSDs was 0.12-0.13/100,000, with prevalence in children 0.03-1.4/100,000 and in adults 0.65-2/100,000. In this systematic review, studies that used uniform diagnostic criteria and confirmed cases after testing for AQP4-IgG were included. The prevalence of NMOSDs was estimated to be <5/100,000 globally. A clear bias was seen in favor of nonwhite and indigenous populations. This review highlights the need for prospective population-based epidemiological studies and the importance of surveys in nonwhite populations around the globe. [ABSTRACT FROM AUTHOR]

Background: Medicine has begun adapting to new information-sharing paradigms in the hyper-connected social media era. In this milieu, the role of journal websites in the dissemination of clinical and research information needs to be reevaluated. Objective: We sought to explore whether reader engagement with neurosurgical journal websites, reflected by the number of article views and downloads, correlated with the eventual number of citations received by the articles. Methods: The websites of all Medline indexed neurosurgical journals were screened to identify those that provided information regarding the number of abstract and full text views and downloads. Articles published in these journals between July 2010 and June 2011 were included in this analysis. Various article attributes were identified and the number of citations per article was obtained from Google Scholar. The impact factors of the selected journals for the year 2010 were obtained from the Journal Citation Reports. Results: Twenty-two journals that had published 2527 articles were finally included in this analysis. The number of abstract views, full-text views, and downloads all correlated strongly with the journal impact factors in 2010 as well as the eventual citations per article. The number of article downloads independently predicted the citations per article on multivariate analysis. Neurology India had significantly higher article views and downloads but lower citations per article than the other journals. Conclusions: Readers were found to engage significantly with neurosurgical journal websites and therefore, open access to articles would lead to increased visibility of articles, resulting in higher citation rates. [ABSTRACT FROM AUTHOR]

Background: Incidental diagnosis of saccular aneurysms is more common with the advent of imaging techniques. Because of the severe morbidity and mortality that they can cause, treatment is chased for them, either microsurgical treatment or endovascular, even when they are diagnosed incidentally. Carotid cave aneurysms are rare, and they seem to have a more benign course compared to other intracranial aneurysms, probably related to the physical enveloping effect of the surrounding structures. Yet, their microsurgical treatment is a serious challenge technically for the neurosurgeon, with its severe morbidity and mortality for the patient. Endovascular techniques have their risks, too. Purpose: In this paper, we analyzed and presented our series of incidentally diagnosed carotid cave aneurysms. Materials and Methods: The age, gender of patients, the size, laterality, and MR angiographic follow-up of aneurysms were reported. Their clinical results were noted. Results: Fifty-six patients who had incidentally been diagnosed with 59 carotid cave aneurysms were followed up. No patient was microsurgically treated, but 15 patients had endovascular treatment for 15 aneurysms. The mean size of 15 treated aneurysms was 4.6 ± 2.1 (range = 2-10) mm, and it was 3.0 ± 1.5 (range = 1.7-10) mm for the untreated aneurysms (n = 44). There was no significant difference between the follow-up times of the treated and untreated groups (P = 0.487). The median follow-up of 59 aneurysms in 56 patients was 52 (mean = 49.6 ± 27.9, range = 1-124) months, with a total follow-up of 244 aneurysm years. None of the patients had subarachnoid hemorrhage related to carotid cave aneurysms during follow-up, and none of the aneurysms had shown growth. Two patients who had endovascular treatment had ischemic complications with minor neurologic deficits. Conclusion: Follow-up can be a reasonable option for the incidental aneurysms that are located and confined to the carotid cave. Additionally, TOF might be a reliable method for follow-up imaging of carotid cave aneurysms. [ABSTRACT FROM AUTHOR]

There is a plethora of papers on the role of stereotactic radiosurgery (SRS) in various benign and malignant intracranial tumors, and it is possible to overlook the most important and landmark studies. Thus, the necessity of citation analysis arises, which reviews the most cited articles and recognizes the impact made by these articles. Utilizing the 100 most cited articles describing the use of SRS for intracranial and spinal pathologies, this article aims to provide meaningful information regarding the historical trends and recent directions in which this field is headed. We performed a search of the Web of Science database using the keywords “stereotactic radiosurgery,” “gamma knife,” “GKRS,” “gamma knife radiosurgery,” “LINAC,” and “Cyberknife” on May 14, 2022. Our search retrieved a total of 30,652 articles published between the years 1968 and 2017. The top 100 cited articles were arranged in descending order based on citation count (CC) and citation per year (CY). The journal with the largest number of publications as well as citation count was the International Journal of Radiation Oncology Biology Physics (n = 33), followed by Journal of Neurosurgery (n = 25). The most cited article was authored by Andrews, which was published in 2004 in The Lancet (1699 CC, 89.42 CY). Flickinger, with 25 papers and 7635 total citations, was the author with the highest impact. Lunsford, with 25 publications and total citations of 7615, was a close second. The USA was the leading country with the maximum number of total citations (n = 23,054). Ninety‑two articles described the use of SRS for intracranial pathologies (metastases, n = 38; AVM, n = 16; vestibular schwannoma, n = 9; meningioma, n = 8; trigeminal neuralgia, n = 6; sellar lesion, n = 2; glioma, n = 2; functional, n = 1; and procedure related, n = 10). Eight studies describing spinal radiosurgery were included, out of which four were on spinal metastases. Citation analyses of the top 100 articles revealed that the focus of research in the field of SRS started with functional neurosurgery and progressed to benign intracranial tumors and AVMs. More recently, central nervous system (CNS) metastases have received the maximum attention with 38 articles, including 14 randomized controlled trials finding a place in the top 100 cited articles. Presently, the use of SRS is concentrated in developed countries. Efforts need to be made for more widespread use in developing nations to bring the maximum possible benefits of this focused noninvasive treatment to a wider population. [ABSTRACT FROM AUTHOR]

Background: Disease-modifying agents like Pioglitazone have shown promising effects on neuroinflammation and homeostasis of amyloid plaques, but there is a lack of research papers providing conclusive evidence. Objectives: This study is aimed to determine the safety and efficacy of Pioglitazone in improving cognitive function in patients with mild-moderate Alzheimer's disease (AD). Materials and Methods: Trials published in the last 12 years were identified from PubMed, Scopus, Cochrane Central, and other trial registries. Five hundred twenty-five records were obtained, from which five studies were included for quantitative analysis. Studies comparing Pioglitazone with a suitable placebo or other oral hypoglycemic agent were considered for review. Data was extracted using a pretested form, which was followed by a risk of bias assessment (ROB) with Cochrane's ROB assessment tool. Results: This meta-analysis included studies where Pioglitazone (15–30 mg) was compared to other oral hypoglycemic agents, placebo, or diabetic diet for a minimum duration of 6 months. Pioglitazone did not show a statistically significant improvement in Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) scores [mean difference (MD): −1.16; 95% confidence interval (CI): −4.14–1.81]. By conducting sensitivity analysis with the removal of one study, significant efficacy was obtained [MD: −2.75; 95% CI: −4.84–−0.66]. The Wechsler Memory Scale-Revised logical memory I (WMS-R) scores had a significant improvement in the Pioglitazone group [MD: 2.02; 95% CI: 0.09–3.95]. Conclusion: Pioglitazone is a safe medication that has a promising effect in slowing the advancement of AD. [ABSTRACT FROM AUTHOR]

Background and Objective: Current recommendations prescribe either nicardipine or labetalol as the first-line treatment for acute hypertension due to ease of use, availability, and low price. However, it is unclear if these drugs have different effectiveness and safety profiles. This systematic review and meta-analysis aimed to compare the efficacy and safety of labetalol and nicardipine in patients with acute stroke. Materials and Methods: MEDLINE via PubMed, Scopus, Embase, and Google Scholar databases were electronically searched for the eligible publications from inception until March 2022. All full-text journal papers in English which compared the efficacy of nicardipine with that of labetalol on lowering blood pressure (BP; or treating hypertension) in all subtypes of acute stroke were included. The Cochrane Collaboration tool was used to assess the risk of bias. Data were analyzed using specific statistical methods. Results: Following the abstract and full-text screening, this meta-analysis included five retrospective cohorts and one prospective pseudorandomized cohort. Nicardipine's effect on time at goal BP was significantly superior to that of labetalol in patients with acute stroke (0.275 standardized mean difference [SMD], 95% confidence interval [CI]: 0.112-0.438, P = 0.001). The incidence of adverse events was significantly higher in the nicardipine group than that in the labetalol group. The pooled odds ratio (OR) was 1.509 (95% CI: 1.077-2.113, I2 = 0.00%, P = 0.757). The quality of included studies was found to be low. Conclusion: More prospective, comparative trials are needed to investigate the efficacy of BP management as well as clinical outcomes in acute stroke patients receiving continuous labetalol and nicardipine infusions. [ABSTRACT FROM AUTHOR]

Early detection of brain tumor has an important role in further developing therapeutic outcomes, and hence functioning in endurance tolerance. Physically evaluating the various reversion imaging (magnetic resonance imaging [MRI]) images that are regularly distributed at the center is a problematic cycle. Along these lines, there is a significant need for PC-assisted strategies with improved accuracy for early detection of cancer. PC-backed brain cancer detection from MR images including growth location, division, and order processes. In recent years, many inquiries have turned to zero in traditional or outdated AI procedures for brain development findings. Presently, there has been an interest in using in-depth learning strategies to detect cerebral growths with an excellent accuracy and heart rate. This review presents a far-reaching audit of traditional AI strategies and in-depth study methods for diagnosing brain cancer. This research paper distinguishes three main benefits i.e. exhibition, estimation and measurements of brain tumour detection. [ABSTRACT FROM AUTHOR]

The book "Write It Up" by Paul J. Silvia is a highly respected resource for researchers and scholars looking to improve their academic writing skills and navigate the complex world of journal publication. Silvia offers valuable recommendations on various challenges, including selecting appropriate journals, crafting different sections of a paper, managing collaborative projects, and submitting and revising manuscripts. The book is part of the American Psychological Association's Series and draws on Silvia's expertise in academic writing and publishing. It covers fundamental elements of effective writing, provides strategies for overcoming obstacles like writer's block, and offers guidance on handling revisions and ethical considerations. The book is accessible and relevant to researchers at all career stages. [Extracted from the article]

Prof B Ramamurthi was a pioneer of Indian neurosurgery and a major force in the development of Indian neuroscience. Founding the Madras Institute of Neurology and later the A Lakshmipathi Neurosurgical Centre (ALNC), both at Madras (or Chennai as it is now called), he developed centres of excellence in his career that spanned over five decades. During this period of time he made Madras, a destination for neurosurgery and neuroscience. Along with his colleagues a large number of publications were produced which influenced the world. Notable among his contributions were those in Stereotaxy for movement disorders, epilepsy, pain and psychiatric illness. He also had notable contributions in brain tumours especially acoustic neurinomas and pituitary tumours. His papers on the low incidence of aneurysms is still quoted widely. Head injuries formed a major part of the neurosurgical work and major contributions were made in that field too. As a developing country with socio-economic issues, infections of the nervous system were seen commonly. His publications on tuberculomas of the brain are noteworthy. He was intrigued by the neurophysiological basis of consciousness. He writings on the subject reflect his attempt to bring together ancient eastern thoughts and concepts of consciousness and life and western science. In the later part of his career he spoke on ethics in and the changing milieu of neurosurgery. While contributions to spinal surgery were not seen in the first half of his career, he along with his colleagues from ALNC published original articles on spinal surgery especially tumours and OPLL. Prof B Ramamurthi, has not only influenced, taught and mentored, during his lifetime, a great many neuroscientists, but he also continues to do so through his publications which continue to be relevant in todays world. A glimpse into his contributions show us how without the technology of today a lot was achieved - and we need to see that, to inspire us to achieve more and to strive for greater heights. [ABSTRACT FROM AUTHOR]

Background: The literature survey shows improvement in cognitive performance following acute bouts of physical exercise and chronic exercise patterns. However, neurocognitive growth through karate, a moderate intensity physical activity, is very limited. The synchronization of the nervous and endocrine system can be best reflected through this martial art form through neurogenesis and cognitive potentiation. Numerous outstanding reviews have summarized these findings for martial arts like judo and taekwondo. This review tries to orchestrate the efficiency of karate in neurocognition. Objective of the Study: The specific aim of this review paper is to magnify the efficiency of karate training in cognitive functions, through its response to neurochemical transmissions and electrophysiological signaling Materials and Method: Numerous related literature were evaluated, screened, and selected using the Preferred Reporting Items for Systematic reviews and Meta-Analyses eligibility criteria. All appropriate publications that satisfied the primary objective of the study were scientifically and schematically presented in this review paper. Results: The psychophysiological effect of karate training and their relation with brain functions have been elaborated. This review compiles the few studies established on the cognitive benefits of karate through the electrical stimuli and neurochemical release. Conclusion: Karate may be effective in advancement of particular brain functions and neurocognitive actions through a life time. Electrophysiological studies have unraveled improved neural efficiency, stress tolerance, working and muscle memory but need further exploration. Similarly, to better understand the effects of karate on neurochemical secretions, further research involvement is required. [ABSTRACT FROM AUTHOR]

Background: Currently, there is still no clear consensus on bridging thrombolysis (BT) before mechanical thrombectomy (MT). In this study, we aimed to compare clinical and procedural outcomes and complication rates of BT versus direct mechanical thrombectomy (d‑MT) in anterior circulation stroke. Methods: A total of 359 consecutive anterior circulation stroke patients who received d‑MT or BT in our tertiary stroke center between January 2018 and December 2020 were retrospectively analyzed. The patients were divided into two groups as Group d‑MT (n = 210) and Group BT (n = 149). The primary outcome was the impact of BT on clinical and procedural outcomes, whereas the secondary outcome was the safety of BT. Results: The incidence of atrial fibrillation was higher in the d‑MT group (p = 0.010). The median duration of the procedure was significantly higher in Group d‑MT than in Group BT (35 vs 27 min, respectively; P = 0.044). The number of patients achieving good and excellent outcomes was significantly higher in Group BT (p = 0.006 and P = 0.03). The edema/malign infarction rate was higher in the d‑MT group (p = 0.003). Successful reperfusion, first‑pass effects, symptomatic intra‑cranial hemorrhage, and mortality rates were similar between the groups (p > 0.05). Conclusions: In this study, BT seems to yield better clinical and procedural outcomes with lower complication rates than d‑MT. These findings may support the additional value of intravenous alteplase in anterior system strokes. Further large‑scale, prospective, randomized‑controlled studies will clarify the gray lines in this consensus, but this paper is important for reflecting the real‑world data in developing countries. [ABSTRACT FROM AUTHOR]

Background: Medial sphenoid wing meningiomas constitute 15%-20% of all intracranial meningiomas. These lesions have a propensity to encase the vessels of the circle of Willis and the surrounding cranial nerves. Thus, radical excision is a difficult proposition.Objectives: In this paper, we analyzed our series of sphenoid wing meningiomas. We describe our surgical strategy, which was based on zone-wise dissection of the tumor. We describe the complications and outcomes of surgery.Materials and Methods: This case series is a retrospective analysis of a single surgeon series of medial sphenoid wing meningiomas operated over a 13-year period. Clinical, radiographic, and outcome variables were studied. The surgical videos were analyzed in detail. The meningioma and its extensions were divided into several zones and a zone-wise strategy for tumor excision was evolved.Results: Twenty-four patients with medial sphenoid wing meningiomas were operated. In 14 patients, Simpson grade 3 excision could be achieved; 5 patients had Simpson grade 4 and 1 patient, grade 5 excision. Four (of 24 patients, 16.7%) had vessel injuries.Conclusions: Medial sphenoid wing meningiomas are difficult lesions to excise radically. Close follow-up of residual lesions (especially if attached to the basal dura) is warranted. Additional modalities of treatment like radiosurgery may be required in case of any progression and for higher-grade lesions. [ABSTRACT FROM AUTHOR]

Background: Endovascular treatment is the preferred treatment for acute ischemic stroke (AIS) due to main artery steno-occlusive disease, but it has temporal and technical limitations. Moreover, there is no established treatment for progressive stroke. Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass is sometimes considered as a treatment option. Objective: The objective of this paper is to review the treatment outcomes of patients with AIS undergoing urgent STA-MCA bypass. Methods and Material: This was a retrospective study including 32 patients diagnosed with AIS treated with urgent STA-MCA bypass at our facility. The patients had small infarct volumes and a large diffusion-perfusion mismatch. Results: New ischemic lesions in postoperative diffusion-weighted images were detected in 15 patients (46.9%), but only four (12.5%) developed paralysis. Hyperperfusion occurred in nine patients (28.1%), and five (15.6%) had bypass occlusion at 1 week. Delayed wound healing were found in four patients (12.5%). Neurological outcome was measured 3 months after onset: Manual Muscle Testing (MMT), 3–5 in 27 patients (84.4%); modified Rankin scale (mRS), 0–2 in 17 patients (53.1%); and 0–3 in 26 patients (81.3%). Prognosis was better in patients who underwent surgery after 24 h of stroke onset (mRS, 0–2 in 56.0% cases and 0–3 in 88.0% at 3 months). Statistical analyses revealed that MMT before surgery had a significant association with favorable outcomes (P = 0.041). Conclusions: Urgent STA-MCA bypass for progressive stroke may result in a good prognosis if the right patients are selected and may play an important role in cases treated 24 h after onset in whom endovascular treatment is ineffective. [ABSTRACT FROM AUTHOR]

Background: Rapid eye movement (REM) sleep behavior disorder (RBD), a parasomnia, after being diagnosed, can predict the emergence of an alpha-synuclein-associated neurodegenerative disease (NDD) in 20-45% and 92% of patients within 5 and 14 years, respectively. RBD is less common in tauopathies, and the studies to evaluate its association with polyglutamine diseases have been very few. Objective: To revisit our knowledge on the significance of RBD in the emergence of NDDs and to review the recent updates in the potential biomarkers, which can help predict the risk of phenconversion into NDDs in idiopathic RBD (iRBD) patients. We also aimed to look at the potential neuroprotective therapies that can potentially be used earlier in iRBD patients. Methods: We conducted a review of the papers, after selecting them from the PubMed database. After a thorough screening, 51 articles were chosen to be included in this review. Results and Conclusion: The prospective studies showed that the risk of phenoconversion of iRBD into overt NDDs increased over the longer duration of follow up. Magnetic resonance imaging (MRI) findings, Electroencephalographic findings along with subtle motor signs, autonomic dysfunction, impaired olfaction, and color vision, among others, can be used to predict the onset of an NDD in iRBD. Phytocannabinoids showed a possible neuroprotective effect in animal studies. Considering how RBD is the antecedent of NDDs, there is a need for additional studies to better understand the utility of the aforementioned biomarkers and institute potential neuroprotective therapies early in the process. [ABSTRACT FROM AUTHOR]

Objective: This paper highlights the hydrocephalus research efforts undertaken at AIIMS, New Delhi, supporting progress in the field.Material: Over a period of three decades, basic research, clinical investigations, and multicentric studies were undertaken. This report will review the work mainly to emphasize the need for future generations to pursue further research. Studies that impacted hydrocephalus care (mainly in India) are described, and some of these findings may be useful in other resource-challenged situations.Results: Investigative studies on the effect of shunting on brainstem auditory evoked responses (BAER), transcranial Doppler (TCD), and CT-SPECT were published offering management options for patients. Participation in the International Infant Hydrocephalus Study (IIHS) study offered opportunities to compare our approaches and develop modifications in patient care. This effort proved shunting was equal or better for young children with congenital aqueductal stenosis. Shunt infection protocols and changes made in a systematic manner helped develop local protocols to reduce postoperative shunt infections.Conclusions: Hydrocephalus research over three decades at AIIMS, New Delhi was productive and educational, confirming that locally performed investigative work can help in decision making. Further studies and active participation in international efforts are necessary to advance the field. [ABSTRACT FROM AUTHOR]

Fetal ventriculomegaly is one of the most frequently diagnosed abnormalities detected prenatally. The finding of additional subtle abnormalities can facilitate accurate prognoses, which may range from normal outcomes to significant neurodevelopmental sequelae. Pathogenesis and imaging patterns of ventriculomegaly and hydrocephalus in the fetus based on the pattern-recognition approach using fetal MRI are reviewed in this paper. This radiological approach may shed light on clinical course prediction and therapeutic efficacy of hydrocephalus in the fetus. [ABSTRACT FROM AUTHOR]

Background: Attention-deficit/hyperactivity disorder (ADHD) is a neuro-developmental disease commonly seen in children and it is diagnosed via extensive interview procedures, behavioral studies, third-party observations, and comprehensive personal history. ADHD causes regional atrophy in brain regions and alters the pattern of functional brain connectivity networks. Automated/computerized methods based on magnetic resonance imaging (MRI) can replace subjective methods for the identification of ADHD.Objectives: The aim of this study was to analyze various machine-learning algorithms for ADHD by feeding in vital input features extracted from functional brain connectivity and different existing methods and to review factors crucial for the diagnosis of ADHD.Methods: This paper is a concise review of machine learning methods for the diagnosis of ADHD from MRI. Techniques for feature extraction, dimensionality reduction/feature selection, and classification, employed in the computerized techniques for the diagnosis of ADHD from MRI and the accuracy of classification offered by the individual methods, are focussed on the review.Conclusions: Machine learning algorithms with features of functional brain connectivity networks as input, with hierarchical sparse feature elimination, exhibits the highest accuracy. Augmentation of the behavioral features does not contribute much to increased accuracy. The level of accuracy offered by the frameworks meant for the computer-aided diagnosis of ADHD, available in the literature, does not justify their feasibility in clinical practice. Computerized methods that exploit highly specific biomarkers of ADHD like brain iron concentration in Globus Pallidus, Putamen, Caudate nucleus, and thalamus as features are not available. [ABSTRACT FROM AUTHOR]

Letter from Dr. Wylie McKissock after Dr. Dastur started work in Bombay It meant more work for Dr. Dastur, who was then the sole neurosurgeon. Dr. Baliga asked Dr. Dastur to return and head this new department. While in Dr. McKissock's department, Dr. Dastur received a request from Dr. They took Dr. Gokhale aside and told him that the sum on the form was ridiculously low and not commensurate with the time and energy Dr. Dastur had spent for their patient. [Extracted from the article]

Background: Seizures often herald the clinical appearance of glioma. Temozolomide (TMZ) is the first-line chemotherapeutic agent that has been used to treat glioma.Objective: We conducted a systematic review to determine seizure outcomes in glioma patients treated with TMZ.Methods and Material: We searched EMBASE and PubMed databases (January 1, 2003-August 26, 2021) by using search terms closely related to glioma, seizure, and temozolomide. Titles, abstracts, and full texts were screened and selected using previously established inclusion and exclusion criteria. The research team members reviewed potential articles and reached a consensus on the final articles to be included.Results: Nine studies containing data from three continents met our inclusion criteria. From several descriptive studies on low-grade gliomas (LGGs), the percentage of patients with partial seizure control after TMZ treatment ranged from 29% to 89.7%, and the percentage of patients with complete seizure control after TMZ ranged from 19.4% to 72%. In a retrospective cohort study of patients with LGGs, there was a marked difference in decreased seizure frequency between patients receiving TMZ and those who did not receive TMZ. In a randomized trial, TMZ seemed to have little effect on seizure control in elderly patients with glioblastoma.Conclusions: At present, there are few high-quality and well-designed clinical studies on TMZ for gliomas-related seizures. In terms of the literature included in this review, TMZ has an inhibitory effect on epilepsy. More randomized controlled trials are needed to elucidate the clinical benefits of TMZ in the treatment of gliomas-related seizures. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment. One of the most devastating complications is complex regional pain syndrome.Objectivities: The aim of this study was to systematically analyze available evidence about complex regional pain syndrome after carpal tunnel syndrome surgery (CTSS), its risks, associated factors, and treatments.Material and Methods: Research conducted from 1962 through December 31, 2018, in the following databases: PubMed, Web of Science, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials. The quality assessment of the methodology followed the definitions by the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. The GRADE system (Grades of Recommendation, Assessment, Development, and Evaluation) was applied to evaluate the efficacy of the stellate ganglion block, one of the most cited and recurrent treatments.Results: Of the 246 studies retrieved, 44 articles were included. Concerning patients' gender, we identified a ratio of 5 females: 3 males. The mean age for women was 57.79, a standard deviation of 14.96, and for men 60.75, a standard deviation of 9.4. Considering the total of primary publications of CTSS outcomes, the accumulated incidence reached the maximum of 0.15 CRPS after CTSS patients/CTSS patients. The known risk factors for CRPS after CTSS: female gender, from the fifth decade of life, tourniquet time, immobilization and surgery on dominant hand.Conclusion: CRPS affects 2-5% of people undergoing CTSS. Its diagnosis is still a challenge and its risk factors are unclear, although it seems more likely to affect women, in the dominant hand. The most used treatments include physiotherapy and stellate ganglion block. Most patients show improvement of symptoms within one year. Further clinical trials comparing treatment modalities are required. [ABSTRACT FROM AUTHOR]

Context: Epilepsy is a common neurological disease and is classified into different types based on features such as the kind of seizure, age of onset, part of brain effected, etc. There are nearly 30 approved anti-epileptic drugs (AEDs) for treating different epilepsies and each drug targets proteins exhibiting a specific molecular mechanism of action. There are many genes, proteins, and microRNAs known to be associated with different epileptic disorders. This rich information on epilepsy-associated data is not available at one single location and is scattered across multiple publicly available repositories. There is a need to have a single platform integrated with the data, as well as tools required for epilepsy research. Methods and Material: Text mining approaches are used to extract data from multiple biological sources. The data is curated and populated within an in-house developed epilepsy database. Machine-learning based models are built in-house to know the probability of a protein being druggable based on the significant protein features. A web interface is provided for the access of the epilepsy database as well as the ML-based tool developed in-house. Results: The epilepsy-associated data is made accessible through a web browser. For a protein of interest, the platform provides all the feature values, and the results generated using different machine learning models are displayed as visualization plots. Conclusions To meet these objectives, we present TREADS, a platform for epilepsy research community, having both database and an ML-based tool for the study of AED targets. [ABSTRACT FROM AUTHOR]

Background and Aim: The threshold values of two-point discrimination (TPD) provide a numerical measure of tactile acuity. Normal reference values are needed to decide whether sensory variability is within normal sensorial limits. The study aimed to determine the upper extremity and face threshold values in healthy young adults. Materials and Methods: Static TPD thresholds of 67 healthy young adults aged 18-35 years were assessed. Eight skin areas in the face and upper extremity on the dominant side were assessed using a "method of limits" approach with an aesthesiometer. Differences between genders were examined with the Mann-Whitney U test. The Spearman correlation analysis investigated the relationship between age and TPD measurements. Results: TPD values ranged between 4.66 and 19.16 mm and 1.33-68.66 mm in the face and upper extremity, respectively, in the participants with a mean age of 23.83 ± 4.66 years. Fingertips and the area over the lateral mandibula showed the greatest sensitivity. The threshold values of TPD showed both interindividual and intraindividual variability. There was no statistical difference in the TPD values according to gender in any of the measured areas, and there was no relationship between age and TPD test values. Conclusions The threshold values of TPD have clinical applicability in various diseases affecting the sensation of the upper extremity and/or face. These data may help the detection of early sensory loss. [ABSTRACT FROM AUTHOR]

Background: The outcome of poor grade subarachnoid hemorrhage (SAH) is dismal. Some of these patients need cerebrospinal fluid (CSF) drainage procedure for the hydrocephalus and intraventricular hemorrhage (IVH) which may precipitate rebleeding. However, aneurysmal rebleed following CSF drainage procedure is controversial. Objective: Our study aimed at analyzing the effect of CSF drainage procedure on aneurysmal rebleeding. Material and Methods: We retrospectively analyzed the records of all the consecutive patients diagnosed with poor grade aneurysmal SAH over three year period. Patients initially requiring either external ventricular drainage (EVD) or lumbar drain (LD) were included in the study group, and the rest (not requiring drainage) were included in the control group. Rebleeding was confirmed on computed tomography. The factors affecting rebleeding were analyzed. Results: Overall 194 patients with poor grade SAH were enrolled in the study (91 males: 103 females; mean age: 50.6 years). The study group had 91 patients (83 EVD and 8 LD) while 103 patients were in the control group. Posterior circulation aneurysms, poor grade SAH, hydrocephalus, and IVH were more common in the study group P < 0.001. The rebleeding rate was 7.6% in the study group and 8.7% in the control group. On univariate analysis size >1 cm, multiplicity, multilobularity, vasospasm, and CSF drainage were significant risk factors for rebleeding (P < 0.001). On multivariate analysis aneurysm size >1 cm, CSF overdrainage >250 ml/day were significantly associated with risk of rebleeding. Conclusion: Ventricular drainage is essential to relieve acute hydrocephalus and drain IVH in SAH and we found no significant association between CSF drainage and rebleeding. However, rapid overdrainage of CSF can lead to aneurysm rupture, hence controlled controlled CSF drainage should be undertaken. [ABSTRACT FROM AUTHOR]

Background: With a steady increase in life expectancy seen worldwide, age-associated cognitive decline and mild cognitive impairment in old age are major public health challenges. Objective: To determine the effectiveness of the Cognitive Rehabilitation Program on cognition parameters in old age people with mild cognitive impairment. Materials and Methods: Design: This study was a quasi-experimental design using a non-equivalent control group pretest post-test design. Setting/Location: Mullana and Adhoya villages of Ambala, Haryana. Subjects: Eighty old age people with mild cognitive impairment. Intervention: The pre- and post-interventional cognition parameters were assessed using Addenbrooke's cognitive examination on Day 1 and Day 29. The cognitive Rehabilitation Program was administered in the experimental group once a day for 28 days. Outcome Measures: Dependent variables were cognition parameters. Results and Conclusion: In the experimental group, a significant increase in cognition parameters score was observed from Day 1 (62.28 ± 6.23) to Day 29 (63.25 ± 5.10) after administration of the Cognitive Rehabilitation Program. In the comparison group, there was a non-significant decrease in cognition parameters score from Day 1 (56.73 ± 8.24) to Day 29 (55.85 ± 8.90). The post-implementation cognition parameters score of old age people in the experimental group (mean = 63.25) was significantly higher than in the comparison group (mean = 55.85). The mean gain in cognition scores was significantly higher in the experimental group than in the comparison group with a moderate effect size. It is concluded that the cognitive rehabilitation program is an effective tool in improving cognition parameters score among old age people with mild cognitive impairment. [ABSTRACT FROM AUTHOR]

This article discusses the use of endoscopic spine surgery (ESS) as a minimally invasive alternative to traditional surgery for lumbar disc herniation. The article presents six successful cases using the interlaminar approach, with favorable postoperative outcomes. However, the article also highlights potential complications and the need for caution during the procedure. The document provides a detailed description of the technique, which involves specialized instruments and a 4K camera system. It emphasizes the importance of proper patient selection and surgeon skill for successful outcomes. [Extracted from the article]

This summary describes a surgical procedure for treating paraclinoid internal carotid artery aneurysms. The procedure involves accessing the aneurysm through a contralateral interoptic approach, which avoids the need for an anterior clinoidectomy or excessive manipulation of the optic nerve. The authors provide detailed steps of the procedure, including incising the lamina terminalis, dissecting the optic nerve, and using microsurgical techniques to dissect and clip the aneurysm. They also discuss the advantages and drawbacks of microsurgical treatment compared to endovascular therapy. The authors conclude that the contralateral interoptic approach is a safe and effective alternative for treating small- to medium-sized paraclinoid aneurysms. [Extracted from the article]

Background: Practicing neuroendoscopic skills like hand-eye coordination is mandatory before embarking on actual surgeries. Synthetic models are able alternatives for cadavers and animals. Presently available models in the literature are either very costly or lack a feedback mechanism, which makes training difficult. Objective: We aimed to make a basic low-cost neuroendoscopic hand-eye coordination model with a feedback mechanism. Methods and Materials: An electronic circuit in series was designed inside a clay utensil to test inadvertent contact of the working instrument with implanted steel pins, which on completion lighted a light-emitting diode (LED) and raised an alarm. Two exercises--moving-a-rubber exercise and passing copper rings of multiple sizes were made and tested by 15 neurosurgeons. Results: The moving-a-rubber exercise was completed by 6/15 (40%) neurosurgeons in the first attempt, 6/15 (40%) in the second, and 3/15 (20%) in the third attempt. For the 1.5 cm copper ring passing exercise, 12/15 (80%) successfully performed in the first attempt; for 1 cm copper ring, 6/15 (40%) performed in the first; and for the 0.5 cm copper ring, 1/15 (6.6%) performed in the first attempt. The time to finish all the exercises significantly decreased in the third successful attempt compared to the first. Conclusion: The model gave excellent feedback to the trainee and examiner for basic neuroendoscopic hand-eye coordination skills. [ABSTRACT FROM AUTHOR]

Background: Acute cerebral infarction (ACI) is a common neurological disease that is associated with high morbidity, disability and mortality rates. At present, antiplatelet therapy is a necessary treatment for ACI. The present study aimed to investigate the effects of omentin-1 on the intravenous thrombolysis of ACI. Objective: The present study aimed to investigate the effects of omentin-1 on the intravenous thrombolysis of ACI. Material and Methods: The mouse model of ACI was induced using male C57BL/6 mice through middle cerebral artery occlusion (MCAO). Meanwhile, the murine BV2 microglial cells were pretreated with 0.1 mg/ml of lipopolysaccharide (LPS), and then induced with 2 mM of adenosine triphosphate (ATP). Results: The omentin-1 mRNA expression in patients receiving intravenous thrombolysis for ACI was down-regulated compared with the normal group. Additionally, the serum level of omentin-1 was negatively correlated with National Institute of Health Stroke Scale (NIHSS) score or serum level of IL-1ß or MMP-2 in patients receiving intravenous thrombolysis for ACI. Meanwhile, the serum mRNA expression of omentin-1 was positively correlated with Barthel index or high-sensitivity C-reactive protein (hs-CRP) in patients undergoing intravenous thrombolysis for ACI. As observed from the in vitro model, Omentin-1 reduced inflammation, promoted cell growth, alleviated ROS-induced oxidative stress, and enhanced AMPK activity through activating NLRP3 ubiquitination. Omentin-1 presented ACI in the mouse model of ACI. Regulating AMPK activity contributed to controlling the effects of Omentin-1 on the in vitro model. Conclusions: Omentin-1 reduced neuroinflammation and ROS-induced oxidative stress in the mouse model of ACI, which was achieved by inhibiting NLRP3 ubiquitination through regulating AMPK activity. Therefore, omentin-1 may serve as a treatment factor for the intravenous thrombolysis of ACI in further clinical application. [ABSTRACT FROM AUTHOR]

Background: Microparticles (MPs) have been implicated in thrombosis and endothelial dysfunction. Their involvement in early coagulopathy and in worsening of outcomes in isolated severe traumatic brain injury (sTBI) patients remains ill defined. Objective: We sought to quantify the circulatory MP subtypes derived from platelets (PMPs; CD42), endothelial cells (EMPs; CD62E), and those bearing tissue factor (TFMP; CD142) and analyze their correlation with early coagulopathy, thrombin generation, and in-hospital mortality. Materials and Methods: Prospective screening of sTBI patients was done. Blood samples were collected before blood and fluid transfusion. MP enumeration and characterization were performed using flow cytometry, and thrombin-antithrombin complex (TAT) levels were determined using enzyme-linked immunosorbent assay (ELISA). Circulating levels of procoagulant MPs were compared between isolated sTBI patients and age- and gender-matched healthy controls (HC). Patients were stratified according to their PMP, EMP, and TFMP levels, respectively (high =HC median and low < HC median). Results: Isolated sTBI resulted in an increased generation of PMPs (456.6 [228-919] vs. 249.1 [198.9-404.5]; P = 0.01) and EMPs (301.5 [118.8-586.7] vs. 140.9 [124.9-286]; P = 0.09) compared to HCs. Also, 5.3% of MPs expressed TF (380 [301-710]) in HCs, compared to 6.6% MPs (484 [159-484]; P = 0.87) in isolated sTBI patients. Early TBI-associated coagulopathy (TBI-AC) was seen in 50 (41.6%) patients. PMP (380 [139-779] vs. 523.9 [334-927]; P = 0.19) and EMP (242 [86-483] vs. 344 [168-605]; P = 0.81) counts were low in patients with TBI-AC, compared to patients without TBI-AC. Conclusion: Our results suggest that enhanced cellular activation and procoagulant MP generation are predominant after isolated sTBI. TBI-AC was associated with low plasma PMPs count compared to the count in patients without TBI-AC. Low PMPs may be involved with the development of TBI-AC. [ABSTRACT FROM AUTHOR]

Background: Proximal anterior cerebral artery (PACA) aneurysms account for less than 1% of all intracranial aneurysms. These aneurysms possess a challenge to surgeons due to their small size, wide base, fragile wall, and accompanying vascular anomalies. Surgery and endovascular treatment are both effective treatment options for PACA aneurysms but there is currently no consensus on which is the method of choice. Objective: A systematic review and meta-analysis was conducted to investigate treatment strategies for aneurysms at proximal anterior cerebral artery. Material and Methods: The Cochrane Library, EMBASE, PubMed, and Web of Science databases were systematically searched for studies published between January 01, 2000 and December 01, 2020 that investigated surgery and/or endovascular treatment for patients with PACA. Results and Conclusions: Nineteen retrospective studies involving 358 patients met the inclusion criteria. Among these patients, 150 were treated surgically and 208 were treated using an endovascular technique. Preoperative morbidity was significantly greater in the surgical patients compared with the endovascular treated patients but there was no difference between groups in procedural related morbidity. The rates of favorable clinical outcome at time of discharge and at follow-up were statistically significantly greater in the endovascular group compared with the surgical group. Procedural related mortality was 8.7% for the surgical group and 1% in the endovascular group. In summary, our meta-analysis emphasized the safety and efficiency of endovascular treatment, and concluded that it was superior to surgery in acquiring favorable clinical outcome and reducing the perioperative complications. However, surgery was still the preferred treatment strategy for ruptured PACA aneurysms. Preoperative evaluation seems to be of great vital. [ABSTRACT FROM AUTHOR]

Background: Almost one-fifth of patients undergoing surgery for sellar/supra-sellar tumors do not gain a significant improvement in their vision. Various methods have been described to predict prospective visual outcomes in them, although they lack uniformity. Objective: The study was conducted to predict visual outcomes following surgery for sellar and supra-sellar tumors compressing the anterior optic pathway based on pre-operative optical coherence tomography (OCT) parameters. Methods and Materials: This was a record-based observational descriptive longitudinal study done in a tertiary care center in India. Thirty-seven patients (74 eyes) diagnosed with sellar supra-sellar lesions were included in the study. Patients' ophthalmic evaluations, done pre-operatively and 3 months post-operatively, were reviewed. Spectral-domain OCT and segmentation were done using the automated segmentation technology of Spectralis software. The thickness of the respective layers was measured. Results and Conclusions: The mean age of the study population was 42.68 years. Eyes with a pre-operative visual acuity component of VIS (visual impairment score) ≤61, pre-operative ganglion cell layer thickness ≥26.31 um, a pre-operative inner plexiform layer thickness of ≥25.69 um, a pre-operative ganglion cell inner plexiform layer thickness of 52.00 um, pre-operative ganglion cell complex thickness ≥84.47 μm, and a pre-operative inner retinal layer thickness of ≥205.25 μm were more likely to have an improved visual outcome. Eyes with a pre-operative duration of visual symptoms of ≥15 months, VIS ≥126.50, a pre-operative decimal visual acuity of <0.035, a pre-operative visual field index of ≤8%, a pre-operative macular thickness of ≤287.06 um, a pre-operative macular RNFL (retinal nerve fiber layer) thickness ≤66.00 μm, and a pre-operative peri-papillary RNFL thickness ≤64.62 μm were unlikely to have visual improvement. [ABSTRACT FROM AUTHOR]

Background: Sexual dysfunction significantly affects interpersonal relationships and overall quality of life. It remains a matter of concern for risk assessment and counseling in patients with ruptured intracranial aneurysms. Objective: To assess the sexual dysfunctions in patients undergoing clipping for ruptured intracranial aneurysms and comparative evaluation among different anterior circulation aneurysms. Method: We prospectively included 40 male patients of ruptured intracranial aneurysms of anterior circulation (age range: 20–60 years; sexually active preoperatively), managed with craniotomy and clipping. We evaluated the sexual outcome in patients with excellent Glasgow outcome score (GOS) five at a minimum one year of follow-up. Patients with GOS-5 status at follow-up were broadly classified into two groups: Anterior communicating artery aneurysm (Acom), and non-Acom) aneurysms. We valued sexual outcome with Subjective Sexual Arousal Scale for Men at follow-up, and compared in the two groups. Results: Mean age of patients was 44.78 ± 9.51 years. Besides 20 Acom aneurysms, other groups included 11 middle cerebral artery aneurysms, five internal carotid artery aneurysms, three posterior communicating artery aneurysms, and one distal anterior cerebral artery aneurysm. The mean follow-up was 24.45 ± 13.58 months. Patients with non-Acom aneurysms had an overall better outcome in the sexual performance domain "P = 0.015," mental satisfaction domain "P = 0.009," and sexual assertiveness domain "P = 0.007." However, there was no statistical difference in partner communication domain "P = 0.593," and partner relationship domain "P = 0.378." Overall, the sexual outcome was inferior in patients treated for Acom aneurysms compared to other anterior circulation aneurysms. Conclusions: In cases of aneurysmal subarachnoid hemorrhage, sexual dysfunctions are common even after good clinical outcomes. The study revealed prominent differences in outcomes on the sexual quality of life in patients harboring Acom aneurysms as compared to anterior circulation aneurysms located off-midline. [ABSTRACT FROM AUTHOR]

This article explores the technique of resecting a tumor in the left superior frontal gyrus while the patient is awake. The use of awake mapping and monitoring is highlighted as crucial in preventing language and motor deficits. The surgical procedure involves the use of navigated ultrasound guidance, cortical stimulation, and functional mapping to identify and preserve functional boundaries. The article also discusses the potential risks and benefits of awake mapping and emphasizes the importance of discussing potential deficits with the patient prior to surgery. The document does not have any financial support or sponsorship and the authors declare no conflicts of interest. The authors of the document are Kartik Multani, Kanchi Jain, Parthiban Velayutham, Prakash Shetty, Vikas Singh, and Aliasgar Moiyadi. [Extracted from the article]

This article discusses a modified posterior transdural approach (PTA) for the treatment of calcified thoracic midline disc herniations. Thoracic disc herniations are rare and can cause a range of symptoms, including motor and sensory deficits, as well as vague symptoms such as chest pain and bowel dysfunction. Surgery is the main treatment option, but historically has been associated with high morbidity rates. The PTA is a safer and more effective alternative to anterior/lateral approaches, and the article provides a detailed description of the surgical technique, along with an illustrative 2-D video. The PTA has shown promising results in treating midline thoracic disc herniations, but further research is needed to confirm its safety and efficacy. [Extracted from the article]

Background: SH3TC2 variations lead to demyelinating recessive Charcot-Marie-Tooth (CMT) disease, which is commonly associated with early-onset scoliosis and cranial neuropathy. Data from Indian ethnicity is limited. Objective: We aim to report the characteristics of patients with SH3TC2-associated neuropathy from an Indian cohort. Patients and Methods: Data of five unrelated subjects with SH3TC2 variations were analyzed. Results: Clinical features included female predominance (n = 4), early-onset neuropathy (n = 2), pes cavus and hammer toes (n = 4), kyphoscoliosis (n = 1), impaired vision and hearing (n = 1), facial muscle weakness (n = 1), impaired kinaesthetic sense (n = 3), tremor (n = 2), and ataxia (n = 1). Four patients had the "CMT" phenotype, while one patient had Roussy-Levy syndrome. All had demyelinating electrophysiology with conduction velocities being "very slow" in one, "slow" in one, "mildly slow" in two, and "intermediate" in one patient. Brain stem auditory evoked potentials were universally abnormal though only one patient had symptomatic deafness. Seven variants were identified in SH3TC2 [homozygous = 3 (c.1412del, c.69del, c.3152G>A), heterozygous = 4 (c.1105C>T, c.3511C>T, c.2028G>C, c.254A>T)]. Except for c.3511C>T variant, the rest were novel. Three patients had additional variations in genes having pathobiological relevance in other CMTs or amyotrophic lateral sclerosis. Conclusion: We provide data on a cohort of patients of Indian origin with SH3TC2 variations and highlight differences from other cohorts. Though the majority were not symptomatic for hearing impairment, evoked potentials disclosed abnormalities in all. Further studies are required to establish the functional consequences of novel variants and their interacting molecular partners identified in the present study to strengthen their association with the phenotype. [ABSTRACT FROM AUTHOR]

Introduction: Neurons are highly energy-dependent and highly specialized cells, showing great sensitivity to oxidative stress (OS). Nitric oxide (NO) and its oxidation products play a central role in neurodegeneration. This study aimed to contribute to the further elucidation of the role of OS in the pathogenesis of amyotrophic lateral sclerosis (ALS). Methods: We assessed NO and superoxide dismutase (SOD) levels in cerebrospinal fluid (CSF) of 24 sporadic ALS (sALS) patients (13 of them presented with spinal form while 11 patients had bulbar form) and 20 controls (CG). Results: The obtained SOD levels in sALS patients were lower than those in CG (p < 0.001), while NO showed higher levels compared to CG (p < 0.001). Observed separately, there were no significant differences in the levels of NO and SOD in CSF between patients about their clinical presentations (p > 0.05). There were significant negative correlations between SOD and NO levels in all sALS patients (r = 0.31, P = 0.025). Significant correlation between SOD and functional rating scale as well as disease progression index was recorded in patients with sALS (r = 0.618. r = 0.425, P < 0.01), while NO levels were significantly associated with disease progression only (r = 0.348, P < 0.01). Conclusion: The data presented clearly support the role of impaired oxidant/antioxidant balance in the pathogenesis of ALS, where NO overproduction and decreased SOD defense activity seem to be particularly involved. The CSF SOD and NO level might serve as useful biomarkers for functional disorder and progression of the disease. [ABSTRACT FROM AUTHOR]

Background: There is an agreement among individuals from different cultures in how they judge the cuteness of a face. There are observations suggesting that some preferences may be neurobiological rather than cultural. Most of the studies conducted use adult faces with a neutral expression; however, the mechanisms involved in rating cuteness are not exactly the same as those involved in the perception of attractiveness. Furthermore, it is not always taken into account that emotional expressions influence the impression on the beauty of a face. The objective of the study is to evaluate the influence of the different emotions on the perception of cuteness of children's faces. Materials and Methods: We included 60 adults and 21 children who observed 150 photographs of children's faces expressing the six basic emotions and had to rate facial cuteness. Results: Participants gave the highest cuteness score to faces with happy emotions (mean [M] = 6.89, 95% confidence interval [CI] 6.48-7.30) and the lowest to those that expressed negative emotions (M = 5.32, 95% CI 4.87-5.78, t(160) = 5.08, P <.001). This was evidenced in adults and children of both genders, regardless of the gender of the stimulus. Conclusions: In our study, we found that facial expression generates an impact on the perception that a subject has on the cuteness of the face. The faces that show happiness were scored as more cute compared to those that expressed anger, disgust, or sadness. We suggest that expression of positive emotions, like a smile, could increase the conducts associated with caring, placing the child in a more favorable situation for the future. [ABSTRACT FROM AUTHOR]

Background and Objective: For 1.3 billion population in India, there are only scarce reports on disability of epilepsy using disability-adjusted life year (DALY) as a measure. Our objective was to estimate DALY using real-life data over a period of time for a cohort of people with epilepsy (PWE) admitted to an Epilepsy Monitoring Unit (EMU) of a tertiary care epilepsy center. Materials and Methods: We ascertained survival status as on December 31, 2016 of all eligible admissions to the EMU between 01/01/2005 and 12/31/2015. We examined the medical records of randomly selected 200 of the 1970 survivors and all the expired PWE (n = 40) for clinical characteristics. The cumulative real-life DALY (cr-DALY) for individual was calculated as the sum of the years lost to disability (YLD) and the years of life lost (YLL). Annual population-based DALY (p-DALY) was estimated from the cr-DALY, total patient-years of follow-up, and regional population prevalence. Results: The cr-DALY per PWE was 17.63 (generalized seizures only). The cr-DALY increased by 23.7% when all seizure types were considered (23.12). PWE with epilepsy onset <10 years of age, focal epilepsy (particularly, extratemporal lobe epilepsy), and premature death had significantly higher cr-DALY. Those who underwent surgery for epilepsy or achieved remission had significantly lower cr-DALY. The computed p-DALY was 583/1,00,000 population (generalized epilepsy contributed 165/1,00,000 population; focal epilepsy contributed 418/1,00,000 population). Conclusion: Our study had identified, for the first time, several determinants that reduced DALY significantly. Real-life DALY, rather than prevalence-based DALY, captures the cumulative disability of affected individuals. Epilepsy leads to loss of 23 years of disability-adjusted life span for the affected person. This can be extrapolated to substantial economic benefits. [ABSTRACT FROM AUTHOR]

Background: Studies on insular gliomas (IGs) generally focus on the oncological endpoints with a relative scarcity of literature focusing on the seizure outcomes. Objectives: To study the predictors of long-term postoperative seizure control in IG and propose a novel risk scoring system. Methods: Histopathologically proven, newly diagnosed adult IGs (>18 years) operated over a 10-year period were studied for postoperative seizure control as per International League Against Epilepsy (ILAE) grades at 6 weeks and at last follow-up (minimum of 6 months, median 27 months). Logistic regression analysis was performed and regression coefficients with nearest integers were used to build a risk prediction model. Receiver operator curve (ROC) analysis determined the predictive accuracy of this model. Results: The 6-week postoperative seizure freedom dropped to 41% at the last follow-up. The seizure-free group lived longer (100.69 months, 95% CI = 84.3-116.99 (60%)) than those with persistent postoperative seizures (27.92 months, 95% CI = 14.99-40.86). Statistically significant predictors (preoperative seizure control status, extent of resection, tumor extension to temporal lobe, and lack of postoperative adjuvant therapy) were used to compute a risk score, the score ranging from 0 to 9. A score of four most optimally distinguished the risk of postoperative seizures with an area under the ROC of 91.4% (95% CI: 84.1%, 98.7%, P < 0.001). Conclusion: In our experience, around 60% of patients obtained seizure freedom after surgery, which reduces over time. Control of seizures paralleled survival outcomes. Our proposed scoring system may help tailor management strategies for these patients. [ABSTRACT FROM AUTHOR]

Background: Rathke's cleft cysts (RCCs) are benign epithelial lesions arising from the Rathke's pouch remnants that fail to regress during embryogenesis. Some RCCs become symptomatic and require treatment. Cyst fenestration and drainage of its contents is the preferred procedure to treat symptomatic cases but carries a risk of recurrence. We propose the use of a novel modified nasoseptal flap technique to partially line the cyst wall to avoid recurrence. Methods: This was a prospective, observational study that included all RCC patients admitted to the Department of Neurosurgery, Aster Medcity, from April 2015 to May 2018. The modified nasoseptal flap technique was performed in all patients. They underwent preoperative and postoperative ophthalmological, endocrine, endoscopic, and MRI evaluations to look for recurrence. Results: Ten patients underwent the modified nasoseptal flap technique. The median follow-up was 36 months. Postoperatively, all patients were relieved from headaches. Moreover, their visual fields and pituitary functions normalized. None of the patients developed recurrence of RCC on follow-up brain MRI. On endoscopic examination, all patients had retained patency of the fenestra. The longest follow-up was 72 months. Conclusions: The modified nasoseptal flap technique maintains patency and avoids recurrence of RCCs on long-term follow-up. [ABSTRACT FROM AUTHOR]

Collagen XII, a member of a protein family called fibril associated collagen with interrupted triple helices (FACIT), is an important component of extracellular matrix and is essential for bridging the neighbouring fibrils. Mutations in collagen XII have been recently described to cause a rare extracellular matrix-related myopathy in those whose phenotype resembles collagen VI-related dystrophies and were negative for pathogenic variants in COL6A genes. The authors report a 4-year old girl presented with a phenotype mimicking Ullrich congenital muscular dystrophy and genetically confirmed to have pathogenic variants in COL12A1 gene thus, expanding the phenotypic spectrum of COL12A1-related myopathy. [ABSTRACT FROM AUTHOR]

Background and Objective: The Chikungunya virus is an alphavirus RNA of the family Togaviridae transmitted by the Aedes mosquito. We aim to report magnetic resonance imaging (MRI) brain findings for neurological complications at our institute during epidemic outbreak. Materials and Methods: A total of 43 seropositive cases of Chikungunya infection underwent MRI brain. Results: Out of 43 patients, 27 (63%) had discrete and confluent supra‑tentorial T2‑weighted (T2W) and fluid‑attenuated inversion recovery (FLAIR) hyper‑intense white matter foci. A total of 14 patients (33%) showed multiple foci/areas of diffusion restriction, and four of these patients had infra‑tentorial T2 & FLAIR hyper‑intense foci with restricted diffusion. In three pediatric age group patients including two neonates, the pattern of involvement was diffuse white matter changes with restricted diffusion. In 30% cases, MRI was normal. Conclusions: Detection of focal or confluent white matter hyper‑intense foci with restricted diffusion on MRI in patients presenting with fever and neurological symptoms has potential to conclude the diagnosis of Chikungunya encephalitis, especially in epidemic settings. [ABSTRACT FROM AUTHOR]