Neurology Outpatient Department Research Articles

Omicron-COVID-19-Related Knowledge in Parkinson's Disease Patients and Their Caregivers: A Cross-sectional Study.

The Omicron variant of SARS-CoV-2 (COVID-19) became the global community's third major cause of worry. In the current study, we deployed a self-reported survey questionnaire to investigate the degree of comprehension, awareness and perception of the Omicron variant of COVID-19 in patients with Parkinson's disease (PD) and their respective caregivers (CGs). Using a standardised questionnaire, we conducted a prospective study on PD patients attending the neurology outpatient department prior to and during the COVID-19 pandemic. The study period was between February and August of 2022. A total of 114 CGs and 134 disease-affected patients were evaluated. Approximately 1.8% of the CGs and 4.5% of the patients contracted the Omicron-COVID-19. Over half of the patients (77.6%) were aware of the Omicron variant, and approximately 40.3% of them were aware of its symptoms. After receiving the Covid immunisation, patients (94.02%) reported no change in symptoms. The percentage of patients and CGs who had no symptoms of the viral infection and were not even got tested ever was 95.5% and 98.2%, respectively. Further, patients (95.5%) opted for the 'offline' as a preferred mode of consultation, citing the precision of treatment being the main reason. No definite correlation between the Omicron variant infection and symptoms of PD could be established. The awareness regarding Omicron variant was largely unknown. More patient-centred research on larger population groups, incorporating literate and urban groups would unravel the knowledge gaps.

Development and validation of a dynamic nomogram for high care dependency during the hospital-family transition periods in older stroke patients

BackgroundThis research aimed to develop and validate a dynamic nomogram for predicting the risk of high care dependency during the hospital-family transition periods in older stroke patients.Methods309 older stroke patients in the hospital-family transition periods who were treated in the Department of Neurology outpatient clinics of three general hospitals in Jinzhou, Liaoning Province from June to December 2023 were selected as the training set. The patients were investigated with the General Patient Information Questionnaire, the Care Dependency Scale (CDS), the Tilburg Frailty Inventory (TFI), the Hamilton Anxiety Rating Scale (HAMA), the Hamilton Depression Rating Scale-17 (HAMD-17), and the Mini Nutrition Assessment Short Form (MNA-SF). Lasso-logistic regression analysis was used to screen the risk factors for high care dependency in older stroke patients during the hospital-family transition period, and a dynamic nomogram model was constructed. The model was uploaded in the form of a web page based on Shiny apps. The Bootstrap method was employed to repeat the process 1000 times for internal validation. The model’s predictive efficacy was assessed using the calibration plot, decision curve analysis curve (DCA), and area under the curve (AUC) of the receiver operator characteristic (ROC) curve. A total of 133 older stroke patients during the hospital-family transition periods who visited the outpatient department of Neurology of three general hospitals in Jinzhou from January to March 2024 were selected as the validation set for external validation of the model.ResultsBased on the history of stroke, chronic disease, falls in the past 6 months, depression, malnutrition, and frailty, build a dynamic nomogram. The AUC under the ROC curves of the training set was 0.830 (95% CI: 0.784–0.875), and that of the validation set was 0.833 (95% CI: 0.766-0.900). The calibration curve was close to the ideal curve, and DCA results confirmed that the nomogram performed well in terms of clinical applicability.ConclusionThe online dynamic nomogram constructed in this study has good specificity, sensitivity, and clinical practicability, which can be applied to senior stroke patients as a prediction and assessment tool for high care dependency. It is of great significance to guide the development of early intervention strategies, optimize resource allocation, and reduce the care burden on families and society.

Comparison of Outcomes of Bell’s Palsy Patients Treated with Steroid and Steroid with Antiviral Drug in a Tertiary Care Hospital

Background: Bell’s palsy is the most common acute mononeuropathy associated with idiopathic unilateral facial weakness, characterized by facial asymmetry. Though steroids have effectiveness in managing Bell’s palsy, the use of antiviral is still debatable. Objective: To compare the outcome of Bell’s palsy with treatment by steroid versus combination of steroid and antiviral drugs. Methodology: A prospective analytical study was performed on 84 patients with acute Bell’s palsy attending at Neurology outpatient department of Mymensingh Medical College Hospital from July 2014 to June 2016. The patients were divided into two groups purposively after initial assessment as per House-Brackmann grading system (HBS). Group-I patients were treated with oral prednisolone and oral valacyclovir and Group-II patients were treated with oral prednisolone only. Both groups received facial exercises as per demonstration and proper eye care throughout the study period. Follow-up was done after 2 weeks, 4 weeks and 3 months for collection of data about recovery according to reassessment. Results: The analysis revealed that recovery rates at all 3 follow-ups were higher in the combination group than that of the prednisolone-only group [29(67.44%) versus 18 (43.90%) at 2nd week follow-up, 35(81.39%) versus 25(60.97%) at 4th week follow up and 40 (93.02%) versus 30(73.17%) at 3rd month follow-up]. Moreover, the expected recovery rate was higher in severe Bell’s palsy patients in the combination group than in steroid-alone group (22, 88.0% complete recovery versus 13, 54.17% complete recovery at the end of 3 months of treatment) [p=0.034]. haemorrhagic shock, spinal cord damage, septic shock and crush syndrome. Conclusion: The study showed antiviral (valacyclovir) plus steroid (prednisolone) to be more effective than steroid (prednisolone) alone in the treatment of Bell’s palsy. Moreover, outcome was more favorable in combination groups presenting with severe disease. Lessen their severity. Journal of Monno Medical College December, 2023; 9 (2):58-62

High Somatization Rates, Frequent Spontaneous Recovery, and a Lack of Organic Biomarkers in Post-Covid-19 Condition.

Many patients report neuropsychiatric symptoms after SARS-CoV-2 infection. Data on prevalence of post-COVID-19 condition (PCC) vary due to the lack of specific diagnostic criteria, the report of unspecific symptoms, and reliable biomarkers. PCC patients seen in a neurological outpatient department were followed for up to 18 months. Neurological examination, SARS-CoV-2 antibodies, Epstein-Barr virus antibodies, and cortisol levels as possible biomarkers, questionnaires to evaluate neuropsychiatric symptoms and somatization (Patient Health Questionnaires D [PHQ-D]), cognition deficits (Montreal Cognitive Assessment [MoCA]), sleep disorders (ISS, Epworth Sleepiness Scale [ESS]), and fatigue (FSS) were included. A total of 175 consecutive patients (78% females, median age 42 years) were seen between May 2021 and February 2023. Fatigue, subjective stress intolerance, and subjective cognitive deficits were the most common symptoms. Specific scores were positive for fatigue, insomnia, and sleepiness and were present in 95%, 62.1%, and 44.0%, respectively. Cognitive deficits were found in 2.3%. Signs of somatization were identified in 61%, who also had an average of two symptoms more than patients without somatization. Overall, 28% had a psychiatric disorder, including depression and anxiety. At the second visit (n=92), fatigue (67.3%) and insomnia (45.5%) had decreased. At visit three (n=43), symptom load had decreased in 76.8%; overall, 51.2% of patients were symptom-free. Biomarker testing did not confirm an anti-EBV response. SARS-CoV-2-specific immune reactions increased over time, and cortisol levels were within the physiological range. Despite high initial symptom load, 76.8% improved over time. The prevalence of somatization and psychiatric disorders was high. Our data do not confirm the role of previously suggested biomarkers in PCC patients.

Visuospatial function impairment in patients with subacute-chronic isolated frontal lobe ischemic stroke: A cross-sectional study using MoCA-Ina in a private hospital

Background. Stroke is one of the leading causes of disability, resulting in both limb disability and also cognitive impairment. Cognitive impairment can occur post-stroke due to lesions in specific cortex areas. Visuospatial function, a domain of cognitive function related to visual imaging, is commonly affected by parietal lobe lesions. However, visuospatial processing also requires sustained attention, planning, and error correction, functions of the frontal lobe. There is a paucity of studies evaluating the relationship between isolated frontal lobe stroke and patients’ visuospatial function. Objective. To analyze the relationship between subacute-chronic frontal lobe ischemic stroke and visuospatial function in post-ischemic stroke patients using the MoCA-Ina. Material and methods. Patients from Siloam Karawaci General Hospital’s neurology outpatient department with ages under 65 years, Glasgow Coma Scale of 15, diagnosis of first-time stroke based on CT scan result, and ischemic lesion confined to one brain lobe were recruited using non-probability consecutive sampling for this cross-sectional study. Patients were divided into frontal lobe and non-frontal lobe stroke subgroups. Visuospatial function was assessed using MoCA-Ina and analyzed using Mann Whitney U test. Outcomes. Fifty patients were included; 25 had frontal lobe stroke, and 25 had non-frontal lobe stroke. The median visuospatial score was lower in the frontal lobe group (2, min/max = 0/4) compared to the non-frontal lobe group (3, min/ max = 0/5), with a p-value of 0.044. There was no significant difference in visuospatial scores between different frontal hemisphere locations. Conclusion. Subacute-chronic frontal lobe ischemic stroke affects visuospatial function in post-ischemic stroke patients.

Predicting efficacy of antiseizure medication treatment with machine learning algorithms in North Indian population

PurposeThis study aimed to develop a classifier using supervised machine learning to effectively assess the impact of clinical, demographical, and biochemical factors in accurately predicting the antiseizure medications (ASMs) treatment response in people with epilepsy (PWE). MethodsData was collected from 786 PWE at the Outpatient Department of Neurology, Institute of Human Behavior and Allied Sciences (IHBAS), New Delhi, India from 2005 to 2015. Patients were followed up at the 2nd, 4th, 8th, and 12th month over the span of 1 year for the drugs being administered and their dosage, the serum drug levels, the frequency of seizure control, drug efficacy, the adverse drug reactions (ADRs), and their compliance to ASMs. Several features, including demographic details, medical history, and auxiliary examinations electroencephalogram (EEG) or Computed Tomography (CT) were chosen to discern between patients with distinct remission outcomes. Remission outcomes were categorized into ‘good responder (GR)’ and ‘poor responder (PR)’ based on the number of seizures experienced by the patients over the study duration. Our dataset was utilized to train seven classical machine learning algorithms i.e Extreme Gradient Boost (XGB), K-Nearest Neighbor (KNN), Support Vector Classifier (SVC), Decision Tree (DT), Random Forest (RF), Naïve Bayes (NB) and Logistic Regression (LR) to construct classification models. ResultsOur research findings indicate that 1) among the seven algorithms examined, XGB and SVC demonstrated superior predictive performances of ASM treatment outcomes with an accuracy of 0.66 each and ROC-AUC scores of 0.67 (XGB) and 0.66 (SVC) in distinguishing between PR and GR patients. 2) The most influential factor in discerning PR to GR patients is a family history of seizures (no), education (literate) and multitherapy with Chi-square (χ2) values of 12.1539, 8.7232 and 13.620 respectively and odds ratio (OR) of 2.2671, 0.4467, and 1.9453 each. 3). Furthermore, our surrogate analysis revealed that the null hypothesis for both XGB and SVC was rejected at a 100 % confidence level, underscoring the significance of their predictive performance. These findings underscore the robustness and reliability of XGB and SVC in our predictive modelling framework. SignificanceUtilizing XG Boost and SVC-based machine learning classifier, we successfully forecasted the likelihood of a patient's response to ASM treatment, categorizing them as either PR or GR, post-completion of standard epilepsy examinations. The classifier’s predictions were found to be statistically significant, suggesting their potential utility in improving treatment strategies, particularly in the personalized selection of ASM regimens for individual epilepsy patients.

An Observational Study of Various Risk Factors and Etiological Profile in Patients with Lower Back Pain at Tertiary Care Center.

The study aimed to analyze the risk factors and etiological profile of lower back pain (LBP) among patients attending a neurology outpatient department at a tertiary care center. A cross-sectional observational study was conducted, involving 170 patients, aged over 18, presenting with LBP between March and August 2023. Sociodemographic and lifestyle data were collected, and diagnostic investigations, including X-ray and magnetic resonance imaging (MRI), were performed. Patients were categorized into acute and chronic LBP groups for analysis. Age-acute LBP was more prevalent in younger patients (<35 years), while chronic LBP was predominant in older age-groups (≥55 years). Gender-females showed a higher prevalence of LBP compared to males, with chronic LBP more common among females. Triggering events-heavy weightlifting was a significant trigger for chronic LBP, while coughing/sneezing was common in acute LBP. Occupation-patients with physically exerting jobs were more prone to acute LBP, while chronic LBP was prevalent among homemakers and those with no work. Body mass index (BMI)-obesity and overweight were associated with chronic LBP. Medication-chronic LBP patients were more likely to be on medication compared to acute LBP patients. MRI findings-prolapsed intervertebral disk (PIVD) was the most prevalent etiology, more common in chronic LBP patients. Other etiologies included vertebral fracture, tumor, tuberculosis, and various spinal conditions. Lower back pain is a multifaceted condition influenced by age, gender, BMI, and lifestyle factors. Effective management and prevention strategies should consider these risk factors to improve patients' quality of life. A comprehensive approach is essential to address the complex etiology of LBP.

Melatonin as an add-on anti-seizure medication in children with epilepsy: An open-label randomized controlled trial

Objectives: The primary objective of this study is to measure the effect of melatonin in decreasing seizure frequency in intervention group as compared to controls in children with drug-resistant epilepsy. Materials and Methods: An open-label randomized controlled trial was conducted from July 2020 to June 2022 in children between 2 and 14 years with drug-resistant epilepsy attending Pediatric and Neurology outpatient department and inpatient department. After noting down baseline seizure frequency, children were randomized into the melatonin group and control group. In the melatonin group, add-on melatonin was added to the existing ASM, and in the control group, ASMs were continued. The primary and secondary outcomes were measured after 3 months of follow-up. Results: The percentage change in the seizure frequency between both groups at the end of 3 months of follow-up was not statistically significant, but the percentage reduction of seizure frequency was more than 50% in the melatonin group. Melatonin was well tolerated in our children except for 4 (22%) who developed minor adverse effects. Conclusion: Add-on melatonin decreases seizure frequency to some extent which was not statistically significant with no major side effects. Further studies are needed to assess add-on melatonin’s long-term effectiveness and safety in children with drug-resistant epilepsy.

Spectrum of neurodegenerative disorders in neurology outpatient department: A cross-sectional study.

Neurodegenerative disorders (NDDs) are a growing global health concern with a rise in prevalence with the aging population, leading to increased healthcare utilization and costs. Understanding its prevalence is crucial for effective diagnostics and resource allocation, especially in developing nations with limited resources. This study aims to explore the frequency and types of NDDs, while also collecting demographic, clinical, and neuro-radiological data from patients with NDDs attending a tertiary care hospital in Nepal. This was a single-center based cross-sectional descriptive study conducted at a Neurology outpatient department in a tertiary level hospital in Nepal in which patients aged 18 and above diagnosed with NDDs (May 2023-July 2023) were included. Data were collected and analyzed in SPSS Inc. This study has been presented by the STROBES guidelines. The mean age of the 71 patients included in the study was 65.6 ± 13.3 years. Parkinsonian disorder (n = 41, 57.7%) was the most common NDD diagnosed. Patients belonging to the age group 60-79 years represented 62% of all outpatient visits. Tremors of the upper extremity and impairment of memory were the most commonly encountered first symptoms at onset. Predominant cognitive changes in our study were memory impairment and mood changes. Extrapyramidal features such as gait disturbance, resting tremor, rigidity, and bradykinesia were present. More than half of the patients had age-related cerebral atrophy on neuroimaging followed by chronic small vessel ischemic changes. Diagnosing NDDs poses challenges, and our study underscores Parkinsonian disorder, specifically Parkinson's disease, as the prevailing neurodegenerative condition in our population. Emphasizing its prevalence among the elderly, particularly with tremors as the primary presenting symptom, highlights the necessity for targeted interventions in this demographic.

Individual and health care provider factors influencing stroke self-management behavior: A cross-sectional study

Background This study aimed to examine individual- and health service provider-related factors that influence the self-management behavior of patients with stroke. Methods This cross-sectional study investigated a cohort of 110 ischemic stroke patients in the neurology outpatient department of Universitas Airlangga Hospital from February 2023 to May 2023. Data were obtained using the following three distinct questionnaires: the general demographic questionnaire, health care provider questionnaire, and modified stroke self-management behavior questionnaire. Results Chi-square test results indicated a significant correlation between age (p = 0.023) and information availability (p = 0.000) with self-management behavior in patients with stroke. However, no significant correlations were observed between gender (p = 1.107), residence (p = 0.859), availability of access (p = 0.093), availability of health facilities (p = 0.065), and collaboration among health workers (p = 0.641) with self-management behavior in patients with stroke. Ordinal logistic regression analysis results indicated that age significantly influenced self-management behavior in patients with stroke (p = 0.034; OR = 2.49). Discussion The presence of reliable information within the hospital setting is expectedly complemented by a strong level of literacy among patients with stroke, thereby facilitating the enhancement of their self-management practices.

A Nomogram to Predict the Risk of Acute Ischemic Stroke in Patients with Maintenance Hemodialysis: A Retrospective Cohort Study

Introduction: Acute ischemic stroke (AIS) stands as a leading cause of death and disability globally. This study aimed to investigate the risk factors and relevance linked with AIS in patients undergoing maintenance hemodialysis (MHD) and to create and validate nomogram models. Methods: We examined the medical records of 314 patients with stage 5 chronic kidney disease (CKD 5) undergoing MHD, who sought neurology outpatient department consultation for suspected AIS symptoms between January 2018 and December 2023. These 314 patients were randomly divided into the training cohort (n = 222) and validation cohort (n = 92). The least absolute shrinkage selection operator (LASSO) regression model was employed for optimal feature selection in the AIS risk model. Subsequently, multivariable logistic regression analysis was used to construct a predictive model incorporating the features selected through LASSO. This predictive model’s performance was assessed using the C-index and the area under the receiver operating characteristic curve (AUC). Additionally, calibration and clinical utility were evaluated through calibration plots and decision curve analysis (DCA). The model’s internal validation was conducted using the validation cohort. Results: Predictors integrated into the prediction nomogram encompassed cardiovascular disease (CVD) (odds ratio [OR] 7.95, 95% confidence interval [CI] 2.400–29.979), smoking (OR 5.7, 95% CI: 1.661–21.955), dialysis time (OR: 5.91, 95% CI: 5.866–29.979), low-density lipoprotein (OR: 2.99, 95% CI: 0.751–13.007), and fibrin degradation products (OR: 5.47, 95% CI: 1.563–23.162). The model exhibited robust discrimination, with a C-index of 0.877 and 0.915 in the internal training and validation cohorts, respectively. The AUC for the training set was 0.857, and a similar AUC of 0.905 was achieved in the validation cohort. DCA demonstrated a positive net benefit within a threshold risk range of 2–96%. Conclusion: The proposed nomogram effectively identifies MHD patients at high risk of AIS at an early stage. This model holds the potential to aid clinicians in making preventive recommendations.

A PROSPECTIVE STUDY TO ASSESS THE QUALITY OF LIFE AMONG THE PATIENTS OF GENERALIZED TONIC-CLONIC SEIZURE RECEIVING TREATMENT PHENYTOIN PLUS CLOBAZAM VERSUS SODIUM VALPROATE PLUS CLOBAZAM THERAPY

Objectives: The objective of the study was to compare effect of phenytoin plus clobazam (Group 1) and sodium valproate plus clobazam therapy (Group 2) on quality of life among generalized tonic-clonic seizures (GTCS) patients attending neurology out-patient department at the tertiary care center in Gwalior district. Methods: The present study was a prospective study conducted between period of February 2019 and January 2020 on 45–45 patients each receiving either phenytoin plus clobazam or sodium valproate plus clobazam dual therapy for the treatment of patients with GTCS. Frequency, percentage, mean, standard deviation, independent student t-test, Chi-square test, and one-way repeated measures of ANOVA were applied, and Bonferroni adjustment was calculated using SPSS version 20 software. P&lt;0.05 was considered to be statistically significant. Results: For question 1, in Group 1, mean score was 3.29±0.45 at 0 month (baseline), which reduced to 2.51±0.50 and 2.11±0.48 at 3 and 6 months, respectively. In Group 2, mean score was 3.31±0.46 at 0 month, which reduced to 2.35±0.48 and 1.95±0.29 at 3 and 6 months. For question 2, in Group 1, mean score was 3.44±0.54 at 0 month (baseline), which reduced to 2.55±0.54 and 2.22±0.51 at 3 and 6 months, respectively. In Group 2, mean score was 3.64±0.48 at 0 month, which reduced to 2.77±0.55 and 2.44±0.54 at 3 and 6 months, respectively. There was statistically significant improvement seen within the group at 3 and 6 months as compared to baseline in both groups for question 1, question 2, question 3, question 4; p&lt;0.01. Conclusion: It can be concluded that both combinations of our study groups have a better impact on quality of life from baseline till the end of the study. However, on comparison between them, we have not found a statistically significant difference.

Serum Leptin levels in newly diagnosed Epileptic Patients.

To compare leptin levels in newly-diagnosed treatment-naive epileptic patients and healthy controls. This case-control study was conducted from January 10 to September 15, 2022, at the Dow University of Health Sciences, Karachi, and comprised newly-diagnosed epileptic patients age 12-35years who had no comorbidity. The subjects were enrolled from the Neurology out-patient department of Civil Hospital, Karachi. Healthy individuals matched for age, gender and body mass index were also enrolled as controls. Blood samples were collected between 8am and 10am for the evaluation of serum leptin levels using enzyme-linked immunosorbent assay. Data was analysed using SPSS 26. Of the 100 subjects, 64(64%) were males and 36(36%) were females. There were 50(50%) cases with mean age 19.34±5.65 years, and 50(50%) controls with mean age 19.76±5.67 (p=0.614). 100% of 50 individuals in control group did not have any family history of epilepsy,while 18% of cases (9) reported a positive family history. Mean leptin level in cases was 31.03±19.37 compared to 5.25±4.03 in the controls (p<0.05). Serum leptin levels were elevated in newly-diagnosed epileptic patients compared to healthy controls.

Migraine Duration as a Potential Amplifier of Obesity.

Migraine is a complex neurovascular disorder with obesity as a notable risk factor. This study aimed to investigate an under-researched area of the association between migraine duration and body composition. Patients with migraine from a neurology outpatient department were enrolled and were categorized into four groups based on illness duration: 1 year, 1-5 years, 5-10 years, and >10 years. Patient demographics, blood biochemistry, and body composition data were collected and analyzed statistically. Patients with migraine were predominantly female, with lower education levels, significant work stress, poor sleep, and limited exercise. Longer migraine duration corresponded to increased obesity metrics. Notably, those patients with under 1 year of illness showed elevated blood lipid and liver function levels, whereas those with >10 years showed increased weight, waist circumference, body mass index, and fat content, despite higher physical activity. Significant positive correlation between obesity metrics and migraine duration was seen in patients who had migraine for >1 year. Our findings indicate that protracted episodes of migraine could amplify obesity tendencies, underscoring the imperative of weight regulation in migraine intervention to diminish ensuing adiposity-associated hazards.

Drug utilization patterns for peripheral neuropathy in a neurology outpatient department at a tertiary care center: A cross-sectional observational study

Background: Peripheral neuropathy is a broad term encompassing any condition that impacts the peripheral nerves. It encompasses a wide range of conditions, presenting with a variety of abnormalities that affect different aspects of both the voluntary (somatic) and involuntary nervous systems (autonomic nervous system). The manifestations of peripheral neuropathy can vary significantly based on the specific nerves affected. This disorder can induce numbness, tingling, or pins and needles sensations along with sharp and pulsating pain. Commonly employed medications for treating peripheral neuropathy encompass analgesics such as opioids and over-the-counter pain relievers, as well as anti-epileptic drugs such as topiramate, gabapentin, and pregabalin. For enhancing the management of peripheral neuropathy, it is imperative to gather data regarding the prevailing utilization trends of medications prescribed for neuropathic pain. Drug utilization studies constitute continuous activity for evidence based therapeutic practices; it implies rational therapy with focus on the prime parameters. This study aims to assess the drug utilization pattern for peripheral neuropathy under various prescriptions which provides the scope for various etiologies and severity requiring judicious choice of drug use. Aims and Objectives: The objective of the study was to assess the pattern of medications dispensed to patients diagnosed with various types of peripheral neuropathy at a tertiary care center and to evaluate the drug regimen given for particular type of peripheral neuropathy. Materials and Methods: It is a cross-sectional observational study conducted at a neurology outpatient department at a tertiary care center. Patients diagnosed with peripheral neuropathy due to various disease conditions were included in the study. Patients were selected through convenient sampling. Prescriptions were reviewed to evaluate the medication profile, comprehensiveness, and concordance with the diagnosed condition. Drug details were analyzed utilizing the descriptive statistics within Statistical Package for the Social Sciences software version 29.0. Results: Our study included a cohort of 110 patients diagnosed with peripheral neuropathy due to various disease conditions. The mean age of the study participants were 43.4 years, 58 were males, and 52 were females. Out of 110 patients 58 (52.7%) patients were prescribed pregabalin + methylcobalamin, 38 (34.5%) patients received methylcobalamin alone, 8 (7.2%) patients received duloxetine, 5 (4.5%) patients received the combination of pregabalin and amitriptyline, and 1 patient with peripheral neuropathy due to hypothyroidism received levothyroxine. Conclusion: In our study, the predominant medication utilized for peripheral neuropathy treatment is the combination of pregabalin and methylcobalamin, with methylcobalamin monotherapy being the subsequent choice.

Aberrant brain functional hubs and causal effective connectivity in menstrually-related and non-menstrually-related migraine without aura.

Menstrual migraine without aura (MRM) is common in female migraineurs and is closely related to cerebral functional abnormalities. However, whether the whole brain networks and directional functional connectivity of MRM patients are altered remains unclear. The purpose of this study was to detect the alterations of resting-state functional networks and directional functional connectivity between MRM and non-menstrual migraine without aura (NMM) patients using functional magnetic resonance imaging (fMRI) with degree centrality (DC) and Granger causality analysis (GCA) methods. In this retrospective and cross-sectional study, 45 MRM and 40 NMM patients (matched in age, gender, and years of education) were recruited in the study between May 2018 and June 2022. All participants had undergone resting-state fMRI scanning at the Neurology and Pain Outpatient Department of Nanjing First Hospital. Their brain functions were analyzed in terms of DC and GCA, with the significant threshold at voxel level P<0.01 and cluster level P<0.05, Gaussian random field corrected. Correlation analysis was adopted to assess the relationships between the fMRI results and clinical features (P<0.05, Bonferroni corrected). Compared with those in the NMM group, MRM patients showed decreased DC in the right insula (T=-4.253). Using the right insula as the seed region, patients with MRM demonstrated enhanced effective connectivity from the right insula to the ipsilateral middle temporal gyrus (T=4.138) and contralateral superior temporal gyrus (T=3.523). Furthermore, the MRM group also showed decreased effective connectivity from several brain regions to the right insula, which included the right inferior occipital gyrus (T=-4.498), left middle frontal gyrus (T=-4.879), right precuneus (T=-4.644), and left inferior parietal gyrus (T=-4.113). The average Self-rating Anxiety Scale score of the MRM group was significantly higher than that of the NMM group [P=0.032, 95% confidence interval (CI): 0.363-7.761]. In the MRM group, disease duration was negatively correlated with the mean value of DC in right insula (r=-0.428, P=0.01). The present research demonstrated that patients with MRM have disruption in insula resting-state functional networks. Disrupted networks contained regions associated with cognitive processes, emotional perception, and migraine attack in MRM patients. These results may improve our comprehension of the neuromechanism of menstrually-related migraine.

The effect of anticonvulsant drugs on serum lipid profile

BACKGROUND AND OBJECTIVES: Epilepsy is a potentially life-shortening brain disorder, the symptoms of which can be successfully treated in most patients with one or more antiepileptic drug (AED). The literature explains the association of AED therapy and dyslipidemia. The changes in lipid fraction may vary with different AED, age group, and study population. The present study was planned to assess the serum lipid profile of adult epileptic patients receiving phenytoin, carbamazepine or sodium valproate therapy and attending Neurology Outpatient Department of Government Medical College, Kottayam, compared to normal healthy controls. METHODOLOGY: A total of 150 epileptic patients on AED monotherapy attending the outpatient department of neurology were evaluated for serum lipid profile. Demographic data and medical history of consenting participants were collected by the use of a semi-structured questionnaire. Fifty age- and sex-matching healthy controls also underwent similar investigation. RESULTS AND DISCUSSION: Over 12 months, 150 patients were recruited with a mean age of 35.54 ± 10.72 years (male-to-female ratio 1:1.27). When compared to normal control population observed statistically significant high mean total cholesterol, triglyceride level in the group receiving phenytoin therapy for more than 1 year. Only significant hypertriglyceridemia is observed in carbamazepine and sodium valproate treated patients. A significant correlation between the duration of anticonvulsant therapy and lipid profile was established. CONCLUSION: Conventional anticonvulsants induce dyslipidemia and monitoring of lipid profile should be done routinely to decrease the morbidity and preserve the quality of life in these (asymptomatic) patients.

Knowledge and attitude on epilepsy among neurology patients and their attendants: Mixed methods research at a tertiary hospital

Abstract Background: Epilepsy is a recurrent and common neurological disorder with less awareness about epilepsy among the public. Sociocultural attitudes have a role to play in epilepsy management. This could be due to misconceptions of the public on witnessing an epileptic seizure. Hence, the current study evaluated knowledge, attitude, and perception of neurology outpatient department and inpatients and their caregivers, at the tertiary care hospital in South India. Materials and Methods: A mixed methods research with a single hospital-based, cross-sectional, quantitative study and the phenomenological type of qualitative study with focused group discussion were performed. A purposive sampling technique was used to select a total of 140 participants for the quantitative study using the Public Attitudes toward Epilepsy questionnaire. Results: Among 140 participants, although 80% have heard of epilepsy through witnessing the episode or mass media, 42% were unaware of it. Seventy percent do not know about triggering factors, or measures to prevent injury during epilepsy and 55% do not know the first aid measures. Forty-nine percent had an unfavorable attitude about epilepsy. Thirty-eight percent of the participants still believe that epilepsy is a kind of insanity. Only 48% believe that person with epilepsy can have a normal life like others. Conclusion: Knowledge and attitude toward epilepsy have improved, however, it is found to be low despite increased literacy rate and access to technology. Community-based health educational campaigns by medical fraternities will be beneficial to alleviate negative attitudes and improve knowledge about epilepsy among the public.

Role of short term Video EEG monitoring and MRI in refractory Epilepsy

Introduction: Inpatient video EEG monitoring is widely used for the diagnosis, seizure classification and pre surgical evaluation of patients with epilepsy. Only few studies have highlighted the role of short term video EEG in the diagnosis of paroxysmal events. The present study was undertaken to identify the role of short term video EEG in refractory epilepsy. Materials &amp; Methods: Forty patients, attending neurology outpatient department in our institution, during the study period, fulfilling the criteria for refractory epilepsy were included. Short term video EEG and MRI Brain were done for all of them. Outcomes measured were 1) Video recording of epileptic seizures with concurrent ictal pattern or psychogenic non epileptic seizure. 2) Identification of new interictal epileptiform discharges, which were not there in the previous routine EEG. 3) Observation of congruency between EEG and MRI Brain. Results: Clinical events were recorded in 12.5% of patients - 7.5% had epileptic seizures and 5% had psychogenic non epileptic seizures recorded. Short term video EEG was abnormal in 70% of the patients, whereas previous routine EEG was abnormal in only 30% and these observations were statistically significant. Short term video EEG was useful in diagnostic classification in 70% of the cases. MRI Brain was abnormal in 35% and among them, 30% had lateralized epiletiform discharges and the congruency between them is not statistically significant. Conclusions: Short term video EEG monitoring could be an initial investigation to sort our more frequent seizure group and proceed to long term VEEG if short term VEEG is inconclusive.

Effectiveness of Pain Neuroscience Education on Chronic Pain in Diabetic Neuropathy

Background: Diabetic neuropathy, a common complication of diabetes mellitus, often leads to chronic pain, significantly impacting the quality of life. Pain Neuroscience Education (PNE) has emerged as a potential intervention to address the bio-psychosocial aspects of chronic pain. This study aimed to evaluate the effectiveness of PNE in combination with conventional therapy in reducing pain and improving the quality of life in individuals with diabetic neuropathy. Objective: The primary objective was to assess the impact of Pain Neuroscience Education combined with conventional therapy on pain levels and quality of life in patients with diabetic neuropathy. Methods: A randomized clinical trial was conducted with 30 participants, divided into two groups: 15 in the treatment group and 15 in the control group. Participants were recruited from neurology and physical therapy outpatient departments and selected based on specific inclusion and exclusion criteria. The treatment group received PNE and conventional therapy (TENS, stretching, and strengthening exercises), while the control group received only conventional therapy. Pain levels were assessed using the Visual Analogue Scale (VAS) at baseline and after 6 weeks of intervention. Results: The pre-treatment VAS scores showed no significant difference between the groups (Treatment: Mean = 57.00, SD = 16.77583; Control: Mean = 56.2667, SD = 15.91705, P = 0.903). Post-treatment, the treatment group exhibited a significant reduction in pain (Mean = 19.6667, SD = 6.39940) compared to the control group (Mean = 45.3333, SD = 14.81634), with a mean difference of 25.66 and a P-value of 0.000. Conclusion: The study demonstrated that Pain Neuroscience Education, when combined with conventional therapy, significantly reduces pain and improves the quality of life in patients with diabetic neuropathy. This suggests that PNE could be an effective component of a multi-modal approach to managing diabetic neuropathy pain.