Search

Summary Background Levofloxacin is an effective bactericidal category III antitubercular drug. There is paucity of studies comparing the role of additional levofloxacin to standard antitubercular regimen in the patients with tuberculous meningitis (TBM). Aims To compare the safety and efficacy of adding levofloxacin to standard four drug ATT regimen (RHZE). Subjects and methods The patients with TBM diagnosed on the basis of clinical, cerebrospinal fluid (CSF) and MRI criteria were included. Children below 15 years, patients with pregnancy, seizures, liver failure, kidney failure and malignancy were excluded. The baseline clinical, CSF and MRI characteristics were noted and consciousness was evaluated by Glasgow Coma Scale (GCS). The patients were randomized to RHZE (rifampicin, isoniazid, pyrazinamide and ethambutol) and RHZEL (RHZE and levofloxacin) groups. Outcome was defined at 6 months. Primary outcome was death and secondary outcomes were disability as assess by Barthel Index score and adverse events. Results Out of 110 TBM patients screened, 57 fulfilled the inclusion criteria. Their median age was 35 (15–75) years. 29 patients received RHZEL and 28 RHZE. The baseline clinical, biochemical and MRI characteristics were similar in the two groups. At 6 months, 11 (19.3%) patients died, 38 (66.7%) had good and 7 (12.3%) poor outcome. There was insignificant survival benefit in RHZEL group compared to RHZE (HR-2.61, 95% CI 0.73–9.36, P = 0.14), 25% patients died in RHZE where as 13.8% in RHZEL group. The disability was not significantly different between the two groups. The composite side effects were also similar between the two groups except for a higher frequency of seizure in RHZEL group (5 Vs 0) which resulted in withdrawal of levofloxacin. Conclusion There was insignificant survival benefit in RHZEL which was associated with high frequency of seizures. [ABSTRACT FROM AUTHOR]

Abstract: GABA (γ-amino butyric acid) receptors have always been an inviting target in the etiology and treatment of epilepsy because of its role as a major inhibitory neurotransmitter in the brain. The aim of our study was to find out the possible role of single nucleotide polymorphisms (SNPs) present in GABRA1 IVS11+15 A>G (rs2279020) and GABRG2 588C>T (rs211037) genes in seizure susceptibility and pharmaco-resistance in northern Indian patients with epilepsy. A total of 395 epilepsy patients and 199 control subjects were enrolled for present study. The genotyping was done by PCR-RFLP methods. The GABRA1 IVS11+15 A>G polymorphism conferred high risk for epilepsy susceptibility at genotype ‘AG’ (P =0.004, OR=1.77, 95% CI=1.20–2.63), ‘GG’ (P =0.01, OR=1.80, 95% CI=1.15–2.80) and G allele level (P =0.001, OR=1.50, 95% CI=1.16–1.92). Moreover this polymorphism was also associated with multiple drug resistance in patients with epilepsy for homozygous variant ‘GG’ genotype (P =0.031, OR=1.84, 95% CI=1.05–3.23) and G allele (P =0.020, OR=1.43, 95% CI=1.05–1.95). However GABRG2 588C>T polymorphism was not found to be associated either with epilepsy susceptibility or with drug resistance. Overall results indicate differential role of different subunits of GABAA receptor subtypes in epilepsy susceptibility and pharmacotherapy. [Copyright &y& Elsevier]

Abstract: Background: Seizures are common in encephalitis but there is paucity of comprehensive studies evaluating predictors of seizures. Aim: To evaluate the frequency and predictors of seizures in encephalitis patients and its effect on outcome. Methods: In a prospective hospital based study, the patients with encephalitis were evaluated clinically and presence of seizure, its type and duration were noted. Patients’ consciousness was assessed by Glasgow coma scale (GCS) score and neurological findings were recorded. Blood count, serum chemistry, electroencephalography (EEG), cranial MRI and CSF examination were done. The diagnosis of encephalitis was based on ELISA and PCR and grouped into herpes, Japanese, dengue and nonspecific encephalitis. Hospital mortality and 3-month outcome were noted. Results: 148 patients with encephalitis whose median age was 26 (range 1–75) years were included. Seizures occurred in 63 (42.6%) patients; 18 of whom had status epilepticus. Seizures were more common in herpes (75%) followed by Japanese (54%) encephalitis. The predictors of seizure in encephalitis were age, GCS score and cortical involvement on MRI. 61% children had seizures compared to 36.6% adults and 53.3% with cortical involvement on MRI had seizure compared to 14.3% without. Seizures were not related to mortality but associated with poor outcome. Conclusion: In encephalitis, seizures occur in 42.6% patients especially in children with low GCS score and having cortical involvement on MRI. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate electroencephalography (EEG) changes in dengue virus infection and correlate these with clinical, laboratory and CT/MRI changes. Methods: Consecutive patients with dengue virus infection were prospectively evaluated. A detailed history and clinical examination were carried out. Level of consciousness was assessed by Glasgow Coma scale (GCS). Cranial CT scan or MRI or both were carried out. EEG was carried out within 24h of hospitalization and repeated after 15–30 days. Outcome was defined at 1 month into death, poor, partial and complete recovery. Results: Twenty-four patients aged 5–65 years with dengue virus infection having neurological manifestations were included; of whom six were females. EEG revealed theta to delta slowing in 11 out of 20 patients. Five of these patients had seizures, 12 altered sensorium, 3 hypotension, 9 CSF pleocytosis, 3 moderate to severe liver dysfunction and 2 MRI abnormalities who had Japanese encephalitis virus coinfection. Presence of EEG slowing correlated with altered sensorium and depth of coma but not with outcome. At 1 month, three patients died and 16 had complete, three partial and two poor recovery. Conclusions: EEG revealed non-specific slowing in 55% patients with dengue virus infection, which correlated with level of consciousness but not with CT/MRI abnormalities or clinical recovery. Significance: Dengue virus infection results in non-specific EEG slowing in 55% patients, which may be due to dengue virus encephalitis per se or associated confounding variables such as seizure, metabolic encephalopathy, or structural brain lesion. [Copyright &y& Elsevier]

Objective: In view of paucity of evoked potential changes in Pott''s paraplegia, it is proposed to evaluate the role of motor and somatosensory evoked potentials in predicting the outcome.Methods: Consecutive patients with Pott''s paraplegia during 1993–2003 were subjected to detailed clinical, radiological and evoked potential study. The latter comprised of tibial somatosensory evoked potential (SEP) and motor evoked potential (MEP) study to tibialis anterior. The patients were clinically evaluated at 6 and 12 months and the outcome was defined into poor (bed ridden), partial (dependent for activities of daily living) and complete recovery (independent). The evoked potential findings were correlated with clinical and radiological findings and outcome.Results: There were 39 patients whose age ranged between 16 and 70 (mean 42.1) years and 22 were females. The mean duration of symptoms was 8.2 months. Sensory motor deficit was present in 18 and pure motor signs in 21 patients. Five patients had quadriplegia and remaining had paraplegia. The muscle weakness was severe in 12 and moderate in 15 patients. In 12 patients, lower limb power was normal but they had lower limb hyper-reflexia with or without spasticity suggesting pyramidal dysfunction. Pinprick and joint position sensations were abnormal in 18 patients. MRI was abnormal in all and revealed cervical involvement in 7, thoracic in 22 and lumbar in 10 patients. Paravertebral soft tissue shadow was present in 36 and cord compression in 30 patients. Motor evoked potential was abnormal in 19 patients (unrecordable in 11 patients, 21 sides and prolonged in 8 patients, 14 sides). SEP was abnormal in 18 patients (unrecordable in 15 patients, 25 sides and prolonged central conduction in 8 patients, 9 sides). Both MEP and SEP were abnormal in 16, normal in 18, and only MEP was abnormal in 3 and only SEP in 2 patients. At 6 month 25 patients had complete, 9 partial and 5 poor recovery. At 1 year 33 had complete and 4 partial recovery. SEP and MEP abnormalities correlated with respective sensory and motor functions, vertebral level and outcome at 6 and 12 months.Conclusions: MEP and SEP both are helpful in predicting 6-month outcome. Combining SEP and MEP gives stronger correlation with 6-month outcome compared to only MEP or SEP. The potential role of evoked potentials in deciding different therapeutic strategies needs further studies. [Copyright &y& Elsevier]

Summary: Background and objective.: There is no study evaluating the role of clinical, evoked potential and radiological parameters in the prognosis of thalamic hemorrhage employing multivariate logistic regression analysis, thus we aimed to evaluate the role of these parameters in predicting the 3 month outcome following thalamic hemorrhage. Setting.:: Tertiary care referral teaching hospital. Methods.: Fifty-three patients with CT proven thalamic hematoma were evaluated. Conscious level was assessed using the Glasgow Coma Score (GCS), severity of stroke by the Canadian Neurological Scale (CNS), while muscle tone, tendon reflexes and power were also recorded. Hematoma size and type, and evidence of ventricular extension were obtained from the CT scan. Hematomas were classified as (A) thalamic with postero-lateral extension or (B) thalamic without postero-lateral extension. Central motor conduction to upper limb and median somatosensory evoked potentials (SEP) were recorded. Outcome was defined at 3 months on the basis of the Barthel Index (BI) with good being a BI of 12 or greater and poor a BI of less than 12. Best predictors of outcome were evaluated by single variable logistic regression analysis followed by multivariate logistic regression. Results.: Age ranged between 35 and 85 years; 18 were women. Mean GCS was 10.4 and CNS was 3.9. Thirty-one patients had type A hematomas and 22 type B. The hematoma was small in 5, medium in 35 and large in 13 patients. Ventricular extension was present in 34 patients. Motor evoked potentials were unrecordable in 36 and central motor conduction time was prolonged in 8 patients. Median SEP was unrecordable in 37 and N9-N20 conduction time was prolonged in 2 patients. At 3 months, 8 patients had died, 24 had good and 21 had poor outcome. On univariate logistic regression analysis diabetes mellitus, GCS, pupillary asymmetry, CNS score, type and size of hematoma and motor and somatosensory evoked potentials were significant in relation to outcome. On multivariate logistic regression analysis, the best predictors of outcome at 3 months were the type of hematoma and CNS score. Conclusion.: CNS score and CT appearance of hematoma are the best predictors of 3 month outcome following thalamic hemorrhage. The proposed model for outcome assessment is simple and easy to apply and could have wide clinical application. [Copyright &y& Elsevier]

Objective: Visual pathways are vulnerable to vitamin B12 deficiency but there is paucity of studies evaluating visual evoked potential (VEP) changes following vitamin B12 supplementation. Our aim was to evaluate the visual evoked potential changes in patients with vitamin B12 deficiency neurological syndrome and their changes after vitamin B12 therapy.Methods: Seventeen patients with vitamin B12 deficiency neurological syndromes diagnosed on the basis of megaloblastic bone marrow or low serum vitamin B12 level or both were subjected to testing of visual acuity, field of vision, colour vision and neurological examination. Cranial magnetic resonance imaging was done in 9 patients and pattern reversal VEP was carried out on admission. P100 latency and amplitude were measured. Visual function and VEP studies were repeated at 3 and 6 months after vitamin B12 therapy.Results: The patients’ age ranged between 17 and 69 years; 7 were females and 16 were lactovegetarians. The duration of symptoms ranged between 10 days and 10 years. Visual acuity, colour vision, field of vision and fundus oculi were normal. VEP revealed prolongation of P100 latency in 10 patients (17 eyes) which was mild in 2, moderate in 10 and marked in 5 eyes. Six months after treatment, P100 latency improved to normal in all except 4 eyes. VEP abnormality was related to duration of illness and antiparietal cell antibodies.Conclusions: VEP is frequently prolonged in patients with vitamin B12 deficiency neurological syndrome although asymptomatic. It usually returns to normal after treatment. [Copyright &y& Elsevier]

Abstract: Background: GABAA receptors influence the susceptibility to seizures, and variations in the receptor genes can contribute to antiepileptic drug resistance also. Methods: We investigated the possible associations of single nucleotide polymorphisms (SNPs) present in GABRA6 c. 1512 T>C, GABRB2 c. 1412 C>T, and GABRR2 c. IVS2C>G genes of GABAA receptors in epilepsy susceptibility and drug resistance in northern Indian patients with epilepsy. After screening a total of 202 healthy controls and 401 epilepsy patients were enrolled in study. The genotyping was done by PCR-RFLP methods. Results: The GABRA6 c. 1512 T>C, polymorphism was conferring risk for epilepsy susceptibility for TC (P=0.018), CC (P=0.0001) genotype and for C allele (P=0.0002). Another polymorphism GABRB2 c. 1412 C>T was also conferring high risk for epilepsy susceptibility CT (P=0.012), TT (P=0.778) genotype and for variant T allele (P=0.034) but was not associated with drug resistance. No association was found with epilepsy susceptibility or with drug resistance in case of GABRR2 c. IVS2C>G gene polymorphism. Conclusion: Overall, our findings suggest significant involvement of alpha (GABRA6) and beta (GABRB2) subunits of GABAA receptor in epilepsy susceptibility in north Indian population. [Copyright &y& Elsevier]