Publications by authors named "Divyani Garg"

48 Publications

Evaluation of the Modified Atkins Diet for the Treatment of Epileptic Spasms Refractory to Hormonal Therapy: A Randomized Controlled Trial.

J Child Neurol 2021 Apr 9:8830738211004747. Epub 2021 Apr 9.

Department of Pediatrics, 28856Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India.

Objectives: We aimed to evaluate the efficacy of the modified Atkins diet in children with epileptic spasms who had failed hormonal therapy.

Methods: Children aged 9 months to 3 years having daily epileptic spasms despite a trial of ACTH or oral prednisolone and 1 additional anticonvulsant medication were enrolled. Children were randomly assigned to receive the modified Atkins diet either immediately or after a delay of 4 weeks. The ongoing anticonvulsant medications were continued unchanged. The primary outcome variable was the proportion of children who achieved spasm freedom as per parental reports at 4 weeks. Secondary outcomes included time to spasm cessation, proportion of children with electroclinical remission, the proportion of children with >50% reduction of spasms at 4 weeks, and adverse effects of the diet. (ClinicalTrials.gov Identifier: NCT03807141).

Results: A total of 91 children were enrolled in the study; 46 in the diet group and 45 in the control group. At the end of 4 weeks, 11 children in the diet group were spasm free compared with none in the control group ( ≤ .001). The median time to achieve spasm cessation was 10 days (interquartile range 9-20). Nine of these had resolution of hypsarrhythmia on electroencephalography (EEG). Thirty (65.2%) in the diet group had >50% reduction in spasms, compared with none in the control group ( < .001). The most common side effect was constipation, noted in 34.8% of the children.

Conclusions: The modified Atkins diet was found to be effective and well tolerated in children with epileptic spasms refractory to hormonal therapy.
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http://dx.doi.org/10.1177/08830738211004747DOI Listing
April 2021

Status Epilepticus in Neonates and Infants.

Ann Indian Acad Neurol 2020 Nov-Dec;23(6):747-754. Epub 2020 Dec 18.

Paediatrics, Lady Hardinge Medical College, New Delhi, India.

Status epilepticus (SE) is a common neurological emergency in childhood associated with high mortality and morbidity. Acute management of seizures along with aggressive evaluation for establishing the underlying cause are crucial determinants of outcome. Neonatal status epilepticus carries the burden of poor neurological outcomes and may lead to global developmental delay as well as persistent seizures. The aetiology and pathophysiological mechanisms of SE in neonates and young infants differ compared to older children and adults. The most common causes of SE in neonates includes hypoxic sequelae, ischemic stroke and intracranial haemorrhage. In infants, febrile status epilepticus and acute symptomatic seizures are more common than remote symptomatic causes. Recent advances in neuroimaging modalities and molecular diagnostic techniques have facilitated better diagnostic precision. There is deplorable lack of evidence evaluating management strategies of SE in this age group. In addition to prompt initiation of antiseizure medications, vitamin supplementation needs to be empirically added. Simultaneously, meticulous evaluation to determine cause must also be conducted. In this review, we discuss challenges and an algorithmic approach to the diagnosis and management of SE in neonates and infants.
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http://dx.doi.org/10.4103/aian.AIAN_189_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7900746PMC
December 2020

The Great Indian Apomorphine Story: Challenges and Its Usage in Parkinson's Disease in the Indian Context.

Neurol India 2021 Jan-Feb;69(1):137-139

Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India.

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http://dx.doi.org/10.4103/0028-3886.310088DOI Listing
March 2021

Steroid Responsive Acute Isolated Ophthalmoplegia: A Rare Presentation of Anti-Gq1b Antibodies Syndrome.

Ann Indian Acad Neurol 2020 Sep-Oct;23(5):739-740. Epub 2020 Dec 8.

Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/aian.AIAN_287_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887498PMC
December 2020

Quadriparesis: An Ode to Defiance.

Authors:
Divyani Garg

Ann Indian Acad Neurol 2020 Sep-Oct;23(5):709. Epub 2020 Jul 24.

Department of Neurology, Lady Hardinge Medical College, New Delhi, India.

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http://dx.doi.org/10.4103/aian.AIAN_418_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887474PMC
July 2020

Teleneurorehabilitation for Parkinson's Disease: A Panacea for the Times to Come?

Ann Indian Acad Neurol 2020 Sep-Oct;23(5):592-597. Epub 2020 Oct 26.

Department of Neurology, Lady Hardinge Medical College, New Delhi, India.

Telemedicine is witnessing a rebirth due to the COVID-19 pandemic and the continuing need for limited-contact or contactless care in medicine. Telerehabilitation, an offshoot of telemedicine, is a valuable yet underexplored tool in the therapeutic armamentarium of patients with neurological conditions, particularly Parkinson's disease (PD). Although there is evidence in literature reporting the use of telerehabilitation and virtual reality-based services in providing rehabilitation to improve speech, swallowing, gait, and postural instability among persons with PD, the evidence is limited due to small patient numbers. Teleneurorehabilitation (TNR) is an underutilized strategy that may be as effective and perhaps more feasible and affordable among Indian PD patients and also allows sustained rehabilitation. In this article, we encapsulate the evidence on the utility and efficacy of TNR among persons with PD and call upon the neurology community to recognize and utilize the valuable asset that TNR may be for PD patients.
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http://dx.doi.org/10.4103/aian.AIAN_566_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887501PMC
October 2020

Neurology and COVID-19: Time to Burn the Candle at Both Ends.

Ann Indian Acad Neurol 2020 Sep-Oct;23(5):584-585. Epub 2020 Nov 7.

Department of Neurology, Lady Hardinge Medical College, New Delhi, India.

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http://dx.doi.org/10.4103/aian.AIAN_652_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887481PMC
November 2020

Intravenous Methylprednisolone Versus Oral Prednisolone for West Syndrome: A Randomized Open-Label Trial.

Indian J Pediatr 2021 Feb 11. Epub 2021 Feb 11.

Division of Neurology, Department of Pediatrics, Kalawati Saran Children's Hospital and Lady Hardinge Medical College, New Delhi, 110001, India.

Objective: To compare intravenous methylprednisolone (IVMP) with oral prednisolone (OP) for the treatment of West syndrome.

Methods: In this randomized, open-label trial, children aged 2 to 30 mo presenting with epileptic spasms with hypsarrhythmia or its variants on EEG were randomized to receive either IVMP (30 mg/kg/d for 3 d followed by oral prednisolone taper) or OP (4 mg/kg/d for two weeks followed by taper). The primary outcome measure was spasms cessation on day 14. Secondary outcomes included time to response, electroclinical remission at 2 and 6 wk, and frequency of adverse effects. ( ClinicalTrials.gov Identifier: NCT03876444).

Results: Sixty children were enrolled; 31 in the IVMP and 29 in the OP arm. Proportion of children achieving spasms cessation at day 14 was similar in both groups (54.8% versus 68.9%, p = 0.26). Time to achieve remission was lower in the IVMP group (mean 5.4 ± 0.9 versus 9.5 ± 2.6 d, p < 0.0001). Electroclinical remission at 2 wk was similar in both groups (51.6% versus 44.8%, p = 0.59) but lower at 6 wk in the IVMP group (45.2% versus 75.9%, p < 0.015). Adverse effects like sleep disturbance, irritability and hypertension were more common in IVMP group whereas weight gain was more common in the OP group.

Conclusions: There was no significant difference in spasms cessation between the groups on day 14 although remission was higher at 6 wk in OP group. Our study suggests that OP was better than IVMP in efficacy and sustained remission with fewer adverse effects.
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http://dx.doi.org/10.1007/s12098-020-03630-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877308PMC
February 2021

Development and Evaluation of a Working Memory Intervention Kit in Children with Epilepsy in Low-Resource Settings.

Indian J Pediatr 2021 Jan 9. Epub 2021 Jan 9.

Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.

Objectives: In this pilot study, the authors developed and evaluated a working memory intervention (WMI) using a combination of mobile phone-based application and an activity booklet, among children with idiopathic generalized epilepsy.

Methods: Pre- and post-intervention cognitive evaluation at 8 wk included: subtests comprising working memory index from Wechsler Intelligence Scale-IV, color cancellation task for sustained attention, and parent's rating from the Conners' ADHD/DSM-IV Scales of the Conners' Rating Scales-Revised.

Results: Fourteen children completed the intervention; one was lost to follow-up. Significant improvement in most working memory parameters occurred at 8 wk: digit span [scaled scores: median 7 (IQR 4-9) to 12 (IQR 9-14.25); p = 0.001]; letter-number sequencing [scaled scores: median 9 (IQR 5-10) to 11.5 (IQR 6.75-13); p = 0.03]; WMI [median 14 (IQR 9-18) to 22 (IQR 16.75-27); p = 0.001] and sustained attention [time for cancellation test improved from 95 (72-117) to 85 (63-98) s; p = 0.001].

Conclusion: This indigenous WMI was feasible and efficacious in improving working memory deficits in CWE in low-resource settings.
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http://dx.doi.org/10.1007/s12098-020-03653-wDOI Listing
January 2021

Classification and comparative analysis of psychogenic nonepileptic seizures (PNES) semiology based on video-electroencephalography (VEEG).

Epilepsy Behav 2021 02 28;115:107697. Epub 2020 Dec 28.

Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. Electronic address:

Background: Multiple classification systems for psychogenic nonepileptic seizures (PNES) based on semiological features have been described. We sought to compare the efficiency of four PNES classification systems.

Methods: We retrospectively analyzed medical and video-electroencephalography (VEEG) records of patients with PNES with at least one typical event recorded on VEEG. Semiology of PNES events was stringently classified using Hubsch, Dhiman, Wadwekar, and Asadi-Pooya's classification systems.

Results: We studied 248 patients with PNES (78% females, mean age 23.1 ± 10.3 years) and reviewed 498 PNES events. Using Hubsch's scheme, we classified events into: dystonic attacks with primitive gestural activity (5.2%), paucikinetic attacks with preserved responsiveness (9.7%), pseudosyncope (59.8%), hyperkinetic prolonged attacks (16.2%) and axial dystonic prolonged attacks (1.6%), and unclassified (7.5%). Using Dhiman's classification, events were: abnormal motor (hypermotor [10.4%]/ partial motor [12.7%]), dialeptic type (58.6%), mixed patterns (17.3%), and unclassified (1%). Using Wadwekar's classification: dystonic attacks with primitive gestural activity (5.2%), paucikinetic attacks with preserved responsiveness (9.6%), pseudosyncope with/without hyperventilation (65.1%), hyperkinetic prolonged attacks involving limbs ± trunk (18.5%), and axial dystonic prolonged attacks (1.6%). Using Asadi-Pooya's classification, events were: hypermotor (30.1%), non-motor (62.9%), and mixed (7.0%). All events could be classified via Wadwekar and Asadi-Pooya systems.

Conclusion: In our study, pseudosyncope/dialeptic/non-motor semiology emerged as most frequent. Most of our patients with PNES had stereotyped semiology. All events could be classified using the schemes by Asadi-Pooya and Wadweker et al. Dhiman et al. scheme could classify 99% and 7.5% remained unclassified using Hubsch et al. scheme.
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http://dx.doi.org/10.1016/j.yebeh.2020.107697DOI Listing
February 2021

Do All Children With Autoimmune Encephalitis Need Aggressive Immunotherapy?: Authors' Reply.

Indian Pediatr 2020 11;57(11):1088

Department of Pediatrics (Neurology Division), Lady Hardinge Medical College, New Delhi, India.

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November 2020

Spinal Tuberculosis Treatment: An Enduring Bone of Contention.

Ann Indian Acad Neurol 2020 Jul-Aug;23(4):441-448. Epub 2020 Jul 16.

Department of Neurology, Institute of Neurosciences, Medanta, Gurugram, Haryana, India.

Spinal tuberculosis is the most common form of extrapulmonary tuberculosis. It is of great importance to neurologists because of the potentially devastating complication of paraplegia, which may set in during active disease or the healed phase. Due to the deep-seated nature of the disease, definitive diagnosis is often challenging. There is no clear consensus on the appropriate duration of therapy for spinal tuberculosis, with various guidelines recommending treatment from as short as 6 months to up to 18 months. In this article, we present a critical appraisal of the evidence on the same. In our opinion, the duration of antitubercular therapy needs to be individualized and the decision to terminate therapy should be multifactorial (clinical, radiological, pathological/microbiological where possible) rather than being enmeshed within any particular guideline.
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http://dx.doi.org/10.4103/aian.AIAN_141_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657285PMC
July 2020

Semiology in Psychogenic Nonepileptic Seizures: Some Additional Facets.

Authors:
Divyani Garg

Psychosomatics 2020 Oct 1. Epub 2020 Oct 1.

Department of Neurology, Lady Hardinge Medical College and Associated hospitals, New Delhi, India. Electronic address:

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http://dx.doi.org/10.1016/j.psym.2020.09.010DOI Listing
October 2020

Diverse Pathophysiology of Sudden Unexpected Death in Epilepsy in Children: Authors' Reply.

Indian Pediatr 2020 10;57(10):972-973

Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India.

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October 2020

Sudden Unexpected Death in Epilepsy (SUDEP) - What Pediatricians Need to Know.

Indian Pediatr 2020 10;57(10):890-894

Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India. Correspondence to: Dr Suvasini Sharma, Associate Professor, Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi 110 001, India.

Sudden unexpected death in epilepsy (SUDEP) is a devastating complication in children with epilepsy. Children with generalized tonic-clonic convulsions, nocturnal seizures, and co-morbid developmental delay/intellectual disability are at higher risk of SUDEP. The pathogenic mechanisms are incompletely understood and involve cardiac, respiratory, autonomic and cerebral dysfunction. Prone positioning is also significantly associated with SUDEP and may be a target for SUDEP prevention. Good epilepsy control also attenuates the risk; hence, it is important to provide adequate antiepileptic drug therapy with stress on drug compliance as well as early surgical referral for seizure control, wherever necessary. It is recommended that parents of children with epilepsy be counseled about the risk factors for SUDEP and potential measures of SUDEP prevention. We herein provide a pediatric perspective of the problem and guidance about parental counselling for its prevention.
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October 2020

Blood pressure targets for young adults: are we being too stringent?

BMJ 2020 10 9;371:m3910. Epub 2020 Oct 9.

Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India.

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http://dx.doi.org/10.1136/bmj.m3910DOI Listing
October 2020

Use of the International League Against Epilepsy (ILAE) 1989, 2010, and 2017 Classification of Epilepsy in children in a low-resource setting: A hospital-based cross-sectional study.

Epilepsia Open 2020 Sep 21;5(3):397-405. Epub 2020 Jun 21.

Department of Pediatrics Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital New Delhi India.

Objectives: This cross-sectional study was designed to test the applicability of the 1989, 2010, and 2017 International League Against Epilepsy (ILAE) classification of epilepsy in children from a resource-limited setting in India.

Methods: Classification of seizure types and syndromes was done through parental interviews and review of medical records in children with epilepsy aged one month to 18 years. Available investigations including EEG, MRI, and metabolic/genetic tests were used in classifying patients as per the 1989, 2010, and 2017 ILAE (level II-epilepsy type) classification. We compared the proportion of children remaining unclassified by each scheme.

Results: Seven hundred and twenty-six children (436 males, mean age 6.4 ± 4.6 years) were enrolled. Using the 1989 ILAE classification, we were able to classify 95.7%, and 82.6% children by the 2010 scheme. The 2017 ILAE classification could classify all 726 children at level I (seizure type), 664 (91.0%) children at level II (epilepsy type), and an electroclinical syndrome could be identified in 409 (56.1%) of the children. An etiology could be identified in 75%, perinatal brain injury being the most frequent. West syndrome was the most common electroclinical syndrome, identified in 22.7% patients. The 1989 ILAE classification system was superior to the 2010 system ( = .01) in epilepsy classification. There was no difference between the 1989 and 2017 schemes ( = .31) or the 2010 and 2017 schemes ( = .10).

Significance: The 2017 ILAE classification, being multidimensional, allowed classification of children who could not undergo extensive evaluation due to economic constraints and also provided room for overlapping etiologies.
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http://dx.doi.org/10.1002/epi4.12401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7469804PMC
September 2020

Irreversible neuropathy in extremely-drug resistant tuberculosis: An unfortunate clinical conundrum.

Indian J Tuberc 2020 Jul 22;67(3):389-392. Epub 2019 Nov 22.

Department of Neurology, Lady Hardinge Medical College and SK Hospital, New Delhi, India.

Drug-resistant tuberculosis is an increasing healthcare challenge. Drug regimen building demands the use of different therapeutic groups, many of which harbor neurotoxicity as a side-effect, whether central or peripheral. Peripheral neuropathy is a major concern as it tends to be severe and usually irreversible. Anti-tubercular drugs that may contribute to peripheral neuropathy include INH, ethambutol, linezolid, cycloserine and para-amino salicylic acid. This potential adverse effect must be balanced against the intrinsically grave prognosis that drug resistant tuberculosis harbors. We present such a clinically challenging case of a 25 years-old female with extremely drug resistant tuberculosis whose treatment necessitated the use of several neurotoxic anti-tubercular drugs, leading to severe sensory peripheral neuropathy who did not improve despite the withdrawal of culprit drugs. She developed positive and negative sensory symptoms in both lower limbs. Nerve conduction studies were suggestive of sensory neuropathy affecting both lower limbs. Alternate causes of peripheral neuropathy including HIV, vasculitis, B12 deficiency and diabetes were ruled out. Despite drug withdrawal, the patient did not improve significantly. This case emphasizes the irreversibility of anti-tubercular therapy-induced peripheral neuropathy, demanding more rigorous clinical screening for the same while managing such patients.
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http://dx.doi.org/10.1016/j.ijtb.2019.11.012DOI Listing
July 2020

Beyond Fever, Cough and Dyspnea: The Neurology of COVID-19.

J Assoc Physicians India 2020 Sep;68(9):62-66

Director, Professor and Head of Department, Department of Neurology, Lady Hardinge Medical College, New Delhi.

The pandemic due to Severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) has rapidly engulfed the entire world, and continues to evolve at an aggressive pace. Although the characteristic concern in patients with COVID-19 is acute respiratory distress, there is meteoric accrual of data on neurological involvement. Neurological manifestations in COVID-19 have staggering diversity, ranging from mild olfactory and gustatory perception abnormalities to necrotising encephalopathy and stroke. Understanding of pathophysiological mechanisms underlying neurological invasion and disease is still nascent, and dictated largely by evidence from previous coronavirus infections which are known to have neuroinvasive potential. It has also been postulated that SARS CoV2 may affect the medullary respiratory centres in the brain stem thereby playing a possible role in causing neurogenic acute respiratory failure. Preliminary data suggest a role of immune hyperinflammation and hyperthrombosis mediating neurological features. Apart from acute neurological manifestations, immune dysregulation may contribute to para and post-infectious complications and potentially, neurodegenerative conditions. These concepts are paramount in developing therapeutic paradigms to mitigate the impact of the pandemic. In this review, we summarise putative pathophysiological underpinnings of neurological manifestations of COVID-19 and guidance for their management.
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September 2020

Neurological Deterioration in Three Siblings: Exploring the Spectrum of Argininemia.

Indian J Pediatr 2021 Mar 8;88(3):266-268. Epub 2020 Aug 8.

Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.

Argininemia or hyperargininemia is a urea cycle disorder caused by deficiency of the enzyme arginase 1. It is inherited in an autosomal recessive fashion. It commonly leads to spastic diplegia in childhood, but other important features include cognitive deterioration and epilepsy. Unlike other disorders of the urea cycle, hyperammonemia is not prominent. The authors report three siblings with genetically proven argininemia who presented with diverse phenotypes but with spasticity being a common feature. Sibling 1 developed motor regression in early childhood, sibling 2 developed delayed motor milestones from early infancy, whereas sibling 3 had global developmental delay in late infancy after a period of normal development. All siblings had mild hyperammonemia only. Early recognition is imperative, not only to initiate ammonia scavenging therapy which may lead to definite clinical improvement, but also to provide genetic counselling.
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http://dx.doi.org/10.1007/s12098-020-03466-xDOI Listing
March 2021

De novo nose-pinching stereotypy with somnolence: Clues to autoimmune encephalitis.

J Neuroimmunol 2020 10 30;347:577348. Epub 2020 Jul 30.

Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India.

Autoimmune encephalitis (AE) is being increasingly recognized as a cause of new-onset movement disorders. Movement disorders in AE are diverse and range from hyperkinetic conditions such as oromandibular dyskinesias, tremors and chorea to hypokinetic ones such as bradykinesia and parkinsonism. Stereotypies have been described in association with anti-NMDAR encephalitis. Similarly, sleep dysfunction is an underrecognized feature in many AE subtypes, prominently anti-IgLON5 although the correlation of phenotype of sleep dysfunction with a particular antibody subtype in AE is unclear. Despite the recognition of both these features as part of an overreaching spectrum in any patient with AE, seldom are they the sole presenting manifestations. Additionally, the challenge is further compounded in a patient who has seronegative AE since neither sleep disturbances nor stereotypies have been well characterized with this condition yet, and the diagnosis is conditional to exhausting a list of ancillary supportive features. In this brief communication, we describe the case of a young man who presented with hypersomnolence and an unusual focal nose-pinching stereotypy of subacute onset who lacked the presence of other typical clinical characteristics such as cognitive/memory impairment and seizures and had negative autoimmune antibodies but responded to immune therapy dramatically. We propose that the presence of de novo hypersomnolence and stereotypy should inform a potential diagnosis of AE.
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http://dx.doi.org/10.1016/j.jneuroim.2020.577348DOI Listing
October 2020

Autoimmune Encephalitis in Children: An Update.

Indian Pediatr 2020 07;57(7):662-670

Neurology Division, Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India. Correspondence to: Dr Suvasini Sharma, Associate Professor, Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, Bangla Sahib Road, New Delhi 110 001, India.

Context: Autoimmune encephalitis has acquired immense significance as a treatable cause of encephalopathy, epilepsy and movement disorders in children. In this review, we discuss the various clinical syndromes, diagnosis, treatment and prognosis in children.

Evidence Acquisition: A MEDLINE search strategy using the following terms (1998-2019) was adopted for this review. Limits of 'Human' and 'English' were applied. Search terms included: "autoimmune encephalitis", "autoimmune encephalitis AND epidemiology", "pathophysiology", "diagnosis" and "treatment" for studies in children. Review articles, practice parameters, guidelines, systematic reviews, meta-analyses, randomized controlled trials, cohort studies, case series and case reports were included.

Conclusions: Autoimmune encephalitis is being increasingly recognized in children. Anti-NMDAR encephalitis is the most common form. Children present with a polysymptomatic presentation including behavioral changes, psychosis, sleep disturbances, mutism, seizures, movement disorders, memory impairment as well as other neurocognitive deficits. Diagnosis is based on suggestive history and ancillary investigations including magnetic resonance imaging, cerebrospinal fluid analysis, and serology for autoantibodies. Treatment is based on immunomodulation of the acute episode followed by maintenance therapy, with earlier initiation being associated with better outcomes. Prognosis depends on the type of clinical syndrome.
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July 2020

Psychiatric co-morbidities and factors associated with psychogenic non-epileptic seizures: a case-control study.

Seizure 2020 Oct 22;81:325-331. Epub 2020 May 22.

Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. Electronic address:

Purpose: Psychogenic non-epileptic seizures (PNES) offer an immense diagnostic and therapeutic challenge. We sought to determine socioeconomic, psychological and demographic factors in PNES compared to age and gender matched epilepsy patients as well as healthy controls. We also examined psychiatric co-morbidities in PNES and epilepsy patients.

Methods: We conducted a case-control study at a tertiary centre in India with three groups including PNES only, age and gender matched epilepsy only and healthy participants. Factors including marital status, family type, education level and psychiatric comorbidities etc. were compared between the three groups. Details of PNES semiology, duration of event and disease were collected. Psychiatric assessment included MINI International Diagnostic Interview based on DSM-IV criteria and Holmes-Rahe Social Readjustment Scale for stress evaluation. The modified Kuppuswamy scale was used to assess socio-economic status.

Results: We enrolled 100 PNES patients (mean age 26.1 ± 10.8 years), 100 epilepsy patients (23.5 ± 9.6 years) and 100 healthy controls (28.9 ± 11.0 years). Ninety per cent of participants were female. Significant factors associated with PNES included family history of epilepsy [OR 20.3 (2.6-155.6) (p = 0.004)], low education including literate/illiterate status [OR 14.1 (2.5-78.9) (p = 0.003)], interpersonal conflict [OR 2.4 (1.1-6.0) (p = 0.05)] and presence of psychiatric comorbidity [OR 60.5 (24.1-152.2) (p < 0.001)] of which major depression was the most common. The current suicide risk was significantly elevated in PNES compared to epilepsy patients (p < 0.001). PNES disease duration correlated with presence of current depression, dysthymia and suicidality but not with other psychiatric comorbidities.

Conclusions: Our results highlight that several socio-economic and demographic factors are associated with occurrence of PNES. High rates of psychiatric comorbidities including current suicide risk emphasise the need for a collaborative neuropsychiatric approach.
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http://dx.doi.org/10.1016/j.seizure.2020.05.007DOI Listing
October 2020

Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay (ARSACS): Case Report of a Novel Nonsense Mutation in the Gene.

Ann Indian Acad Neurol 2020 May-Jun;23(3):395-397. Epub 2020 May 9.

Department of Neurology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

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http://dx.doi.org/10.4103/aian.AIAN_670_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313614PMC
May 2020

Left-Hand Motor Stereotypy in Vitamin B12 Deficiency: Expanding the Spectrum of Infantile Tremor Syndrome.

Ann Indian Acad Neurol 2020 May-Jun;23(3):389-390. Epub 2020 Apr 7.

Department of Neurology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.

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http://dx.doi.org/10.4103/aian.AIAN_63_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313601PMC
April 2020

Lithium-Induced Lingual Dystonia.

Ann Indian Acad Neurol 2020 May-Jun;23(3):383-384. Epub 2020 Jun 10.

Department of Neurology, Lady Hardinge Medical College, New Delhi, India.

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http://dx.doi.org/10.4103/aian.AIAN_369_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313558PMC
June 2020

Ipsilesional Torsional Nystagmus in Midbrain Infarction: A Rare Entity of Localizing Value.

Ann Indian Acad Neurol 2020 May-Jun;23(3):378-379. Epub 2020 May 9.

Department of Neurology, Lady Hardinge Medical College, New Delhi, India.

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http://dx.doi.org/10.4103/aian.AIAN_646_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313563PMC
May 2020

Apomorphine in Parkinson's Disease-The Questions Raised.

Ann Indian Acad Neurol 2020 May-Jun;23(3):377-378. Epub 2020 Jun 10.

Department of Neurology, Lady Hardinge Medical College, New Delhi, India.

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http://dx.doi.org/10.4103/aian.AIAN_11_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313595PMC
June 2020

Opsoclonus in Scrub Typhus.

Ann Indian Acad Neurol 2020 May-Jun;23(3):367. Epub 2020 Jun 10.

Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India.

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http://dx.doi.org/10.4103/aian.AIAN_230_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313607PMC
June 2020

The role of cardiac I-metaiodobenzylguanidine scintigraphy in multiple system atrophy.

Authors:
Divyani Garg

Psychogeriatrics 2020 Sep 19;20(5):811. Epub 2020 Jun 19.

Department of Neurology, Lady Hardinge Medical College, New Delhi, India.

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http://dx.doi.org/10.1111/psyg.12580DOI Listing
September 2020