Publications by authors named "Sruthi S Nair"

24 Publications

  • Page 1 of 1

Determinants of Suboptimal Outcome Following Thymectomy in Myasthenia Gravis.

Neurol India 2021 Mar-Apr;69(2):419-425

Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.

Background: Response to thymectomy in myasthenia gravis (MG) is influenced by various patient-, disease-, and therapy-related factors.

Methods: Retrospective analysis of 128 patients with MG who underwent maximal thymectomy over 15 years was done to identify the determinants of suboptimal clinical outcome.

Results: Among the 128 patients, 62 (48.4%) were females with a mean age of 38.97 (12.29) years. Thymomatous MG occurred in 66 (51.6%). Overall improvement from preoperative status was noted in 88 (68.8%) patients after mean follow-up of 51.68 (33.21) months. The presence of thymoma was the major predictor of suboptimal clinical outcome (P = 0.001), whereas age, gender, preoperative disease severity, and seropositive status did not attain significance. Patients with better outcome had received higher steroid dose preoperatively (P = 0.035).

Conclusions: Suboptimal response after thymectomy occurred in one-third of MG patients, more commonly with thymomatous MG. Relationship of preoperative steroid therapy to remission merits evaluation.
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http://dx.doi.org/10.4103/0028-3886.314565DOI Listing
April 2021

Adult-onset subacute sclerosing panencephalitis.

Pract Neurol 2021 Apr 13. Epub 2021 Apr 13.

Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India

Subacute sclerosing panencephalitis (SSPE) is a lethal slow viral disease of the central nervous system caused by a defective measles virus. The onset is mostly in childhood, manifesting clinically as decline in academic performance, behavioural changes, motor dysfunction and myoclonus. Adult-onset SSPE is rare and can present as rapidly progressive dementia. We present a young man of Indian origin with adult-onset SSPE with rapidly progressive dementia but no localising neurological signs. The diagnostic clues were parieto-occipital white matter changes on MR brain scan and history of childhood fever with rash. High titres of antimeasles antibody in cerebrospinal fluid confirmed the diagnosis. The long latency from primary measles virus infection to symptom onset can be misleading in adults. SSPE should be considered in adults with dementia, especially in tropical countries where vaccination coverage is suboptimal.
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http://dx.doi.org/10.1136/practneurol-2020-002880DOI Listing
April 2021

Skeletal complications in congenital insensitivity to pain and anhidrosis: a problem to reckon with.

Neurol Sci 2021 Mar 19. Epub 2021 Mar 19.

Pediatric Neurology and Comprehensive Care Centre for Neurodevelopmental Disorders, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India.

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http://dx.doi.org/10.1007/s10072-021-05181-7DOI Listing
March 2021

Quantitative susceptibility-weighted imaging in predicting disease activity in multiple sclerosis.

Neuroradiology 2021 Jan 5. Epub 2021 Jan 5.

Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India.

Purpose: Repeated use of Gadolinium (Gd) contrast for multiple sclerosis (MS) imaging leads to Gd deposition in brain. We aimed to study the utility of phase values by susceptibility weighted imaging (SWI) to assess the iron content in MS lesions to differentiate active and inactive lesions.

Methods: MS persons who underwent MRI were grouped into group 1 with active lesions and group 2 with inactive lesions based on the presence or absence of contrast enhancing lesions. Phase values of lesions (P) and contralateral normal white matter (P) were calculated using the SPIN software by drawing ROI. Subtracted phase values (P = P - P) and iron content (P/3) of the lesions were calculated in both groups.

Results: We analyzed 69 enhancing lesions from 22 patients (group 1) and 84 non-enhancing lesions from 29 patients (group 2). Mean-subtracted phase values and iron content corrected for voxels in ROI were significantly lower in enhancing lesions compared to non-enhancing lesions (p < 0.001). A cut-off value 2.8 μg/g for iron content showed area under the curve of 0.909 with good sensitivity.

Conclusion: Quantification of iron content using SWI phase values holds promise as a biomarker to differentiate active from inactive lesions of MS.
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http://dx.doi.org/10.1007/s00234-020-02605-7DOI Listing
January 2021

Teaching Neuro Images: A rare adult-onset genetic leukoencephalopathy.

Neurology 2020 Nov 18. Epub 2020 Nov 18.

From the Department of Neurology (P.R., H.R., S.S.N.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India; Department of Imaging Sciences and Interventional Radiology (S.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.

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http://dx.doi.org/10.1212/WNL.0000000000011233DOI Listing
November 2020

Consensus Statement On Immune Modulation in Multiple Sclerosis and Related Disorders During the COVID-19 Pandemic: Expert Group on Behalf of the Indian Academy of Neurology.

Ann Indian Acad Neurol 2020 Apr 13;23(Suppl 1):S5-S14. Epub 2020 Apr 13.

Department of Neurology, Bombay Hospital, Mumbai, Maharashtra, India.

Knowledge related to SARS-CoV-2 or 2019 novel coronavirus (2019-nCoV) is still emerging and rapidly evolving. We know little about the effects of this novel coronavirus on various body systems and its behaviour among patients with underlying neurological conditions, especially those on immunomodulatory medications. The aim of the present consensus expert opinion document is to appraise the potential concerns when managing our patients with underlying CNS autoimmune demyelinating disorders during the current COVID-19 pandemic.
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http://dx.doi.org/10.4103/0972-2327.282442DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213028PMC
April 2020

The SARS-CoV-2/COVID-19 pandemic and challenges in stroke care in India.

Ann N Y Acad Sci 2020 08 12;1473(1):3-10. Epub 2020 May 12.

Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India.

Stroke care in India has evolved rapidly in the last decade with a focus on stroke awareness, prevention, rapid triage, treatment, and rehabilitation. But acute stroke care and poststroke rehabilitation in the country have limitations owing to the economic constraints and poor access to health care. The SARS-CoV-2/COVID-19 pandemic has made stroke care even more challenging. We outline the unfavorable circumstances in stroke care induced by the pandemic; propose mitigating measures; crisis management; and provide a comparative evaluation of stroke care between India and the United States during the pandemic. There is a need for public health systems in both developed and developing countries to improve awareness, implement proper strategies of triage, acute treatment, well-defined rehabilitation plans, telemedicine services, and virtual check-ins.
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http://dx.doi.org/10.1111/nyas.14379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273096PMC
August 2020

Clinical and Genetic Profile of Autism Spectrum Disorder-Epilepsy (ASD-E) Phenotype: Two Sides of the Same Coin!

Clin EEG Neurosci 2020 Nov 2;51(6):390-398. Epub 2020 Mar 2.

Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.

The clinical phenotype of autism spectrum disorder and epilepsy (ASD-E) is a common neurological presentation in various genetic disorders, irrespective of the underlying pathophysiological mechanisms. Here we describe the demographic and clinical profiles, coexistent neurological conditions, type of seizures, epilepsy syndrome, and EEG findings in 11 patients with ASD-E phenotype with proven genetic etiology. The commonest genetic abnormality noted was mutation (3), mutation (2), and 1p36 deletion (2). The median age of onset of clinical seizures was 6 months (range, 10 days to 11 years). The most common seizure type was focal onset seizures with impaired awareness, observed in 7 (63.6%) patients followed by epileptic spasms in 4 (30.8%), generalized tonic-clonic and atonic seizures in 3 (27.3%) patients each and tonic seizures in 2 (18.2%) patients and myoclonic seizures in 1 (9.1%) patient. Focal and multifocal interictal epileptiform abnormalities were seen in 6 (54.6%) and 5 (45.5%) patients, respectively. Epileptic encephalopathy and focal epilepsy were seen in 7 (63.6%) and 4 (36.4%) patients, respectively. The diagnostic yield of genetic testing was 44% (11 of 25 patients) and when variants of unknown significance and metabolic defects were included, the yield increased to 60% (15 of 25 patients). We conclude that in patients with ASD-E phenotype with an underlying genetic basis, the clinical seizure type, epilepsy syndrome, and EEG patterns are variable. Next-generation exome sequencing and chromosomal microarray need to be considered in clinical practice as part of evaluation of children with ASD-E phenotype.
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http://dx.doi.org/10.1177/1550059420909673DOI Listing
November 2020

Horizontal gaze palsy and progressive scoliosis-a tale of two siblings with ROBO3 mutation.

Ophthalmic Genet 2020 02 20;41(1):99-100. Epub 2020 Feb 20.

Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.

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http://dx.doi.org/10.1080/13816810.2020.1727537DOI Listing
February 2020

Teaching NeuroImages: Hypomyelinating leukodystrophy with generalized dystonia.

Neurology 2020 01;94(3):e335-e336

From the Department of Imaging Sciences and Intervention Radiology (S.V.) and Comprehensive Care Centre for Neurodevelopmental Disorders (S.S.), Department of Neurology (S.S.N.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.

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http://dx.doi.org/10.1212/WNL.0000000000008827DOI Listing
January 2020

Congenital myasthenic syndrome: Ten years clinical experience from a quaternary care south-Indian hospital.

J Clin Neurosci 2020 Feb 27;72:238-243. Epub 2019 Dec 27.

Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India. Electronic address:

Background: To ascertain the frequency, clinical spectrum and outcome of congenital myasthenic syndrome (CMS) patients who reported to the neuromuscular division of our quaternary medical center during the past ten years.

Methods: We performed a retrospective analysis of all the CMS patients who reported to us during the study period.

Results: Twenty-one patients of CMS attended our quaternary hospital over the past ten years. The median follow-up was 24 (IQR: 16.5-67.3) months. All the patients showed an overall improvement in the last follow up. The diagnosis of CMS could be genetically confirmed in seven cases. Four patients had COLQ mutation, two had CHRNε mutation and one had MUSK mutation. All the cases of COLQ mutation and one case of MUSK mutation had a limb-girdle (LG) presentation. Our study and review of literature imply that CMS should be suspected in cases of seronegative myasthenia gravis cases if the onset is at less than 20 years and strongly so if the onset is within the first two years of life. In addition, a positive family history, delayed motor milestones, and a poor response to immune-modulators should be actively sought for as indicators of CMS.
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http://dx.doi.org/10.1016/j.jocn.2019.11.030DOI Listing
February 2020

Homozygous sequestosome 1 () mutation: a rare cause for childhood-onset progressive cerebellar ataxia with vertical gaze palsy.

Ophthalmic Genet 2019 08 16;40(4):376-379. Epub 2019 Sep 16.

Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology , Trivandrum , India.

Mutations in sequestosome 1 () gene are associated with neurodegenerative diseases, such as frontotemporal dementia and amyotrophic lateral sclerosis. Recently, mutation in was also found to cause a progressive childhood-onset cerebellar ataxia. We describe here a case of progressive childhood-onset cerebellar ataxia with vertical supra nuclear gaze palsy with no family history and a normal magnetic resonance imaging (MRI) of brain. The clinical exome sequencing in this patient showed a homozygous mutation in . This case highlights the importance of next-generation sequencing in the diagnosis of inherited ataxia syndromes. mutation should be considered in the differential diagnosis in a patient with both cerebellar ataxia and ophthalmological manifestations.
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http://dx.doi.org/10.1080/13816810.2019.1666414DOI Listing
August 2019

Electroneurography and Advanced Neuroimaging Profile in Pediatric-onset Metachromatic Leukodystrophy.

J Pediatr Neurosci 2019 Apr-Jun;14(2):70-75

Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.

Context: Metachromatic leukodystrophy (MLD) is a rare autosomal-recessive disorder characterized by demyelination of central and peripheral nervous system. There is scarcity of literature on the electrophysiological aspects of peripheral nerves and the advanced neuroimaging findings in MLD.

Aim: The aim was to study the nerve conduction parameters and advanced neuroimaging findings in patients with MLD.

Materials And Methods: This study is a retrospective analysis conducted, between 2005 and 2016, of 12 patients who had biochemical, histopathological, or genetic confirmation of MLD and disease onset before 18 years of age. The clinical, electroneurography, and the advanced neuroimaging findings were reviewed and analyzed.

Statistical Analysis: The data were presented as percentages or mean ± standard deviation as defined appropriate for qualitative and quantitative variables.

Results: Mean age of onset was 4.84 (±4.60) years and seven patients were males. Eight patients had juvenile MLD and four had late infantile MLD. Clinical presentation of psychomotor regression was more common in infantile MLD (75%), whereas gait difficulty (62.5%) and cognitive impairment (37.5%) were more frequent in juvenile MLD. Nerve conduction study (NCS) revealed diffuse demyelinating sensorimotor peripheral neuropathy in 9 (75%) patients. One patient had a rare presentation with conduction blocks in multiple nerves with contrast enhancement of cauda equina. Diffusion restriction involving periventricular and central white matter was seen in five patients and bilateral globus pallidi blooming was noted in three patients.

Conclusion: This study highlights the utility of NCS and advanced magnetic resonance imaging sequences in the diagnosis of MLD.
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http://dx.doi.org/10.4103/jpn.JPN_155_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712919PMC
September 2019

'Whiskey in my pee' - Rhabdomyolysis in a patient with alcohol binge.

Asian J Psychiatr 2019 Aug 10;44:70-71. Epub 2019 Jul 10.

Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India. Electronic address:

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http://dx.doi.org/10.1016/j.ajp.2019.07.025DOI Listing
August 2019

An unusual presentation of scleromyxedema as inflammatory myopathy.

Acta Myol 2019 03 1;38(1):13-16. Epub 2019 Mar 1.

Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.

Scleromyxedema is a rare cutaneous mucinosis with frequent extracutaneous manifestations. Myopathy in scleromyxedema is a poorly recognized syndrome among neurologists and can mimic idiopathic and connective tissue disease-associated inflammatory myopathy. Diagnosis is suspected by the characterization of the skin lesions and clinched by skin and muscle biopsies. Here, we report a patient with scleromyxedema and myopathy with the characteristic histopathological feature of mucin deposition in skin biopsy. Her muscle biopsy showed a picture consistent with scleromyxedema myopathy with vacuolar and inflammatory changes. The association with paraproteinemia, propensity to life-threatening central nervous system disease and good response to intravenous immunoglobulin necessitate the accurate diagnosis of this condition.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598408PMC
March 2019

Relapsing lumbosacral myeloradiculitis: An unusual presentation of MOG antibody disease.

Mult Scler 2020 04 1;26(4):509-511. Epub 2019 Apr 1.

Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Thiruvananthapuram, India.

Myelin oligodendrocyte glycoprotein antibody (MOG-Ab) seropositivity is being increasingly reported in diverse demyelinating syndromes with monophasic and relapsing presentations. Conus myelitis is described as a typical feature of MOG-Ab seropositivity. However, the association with lumbosacral radiculitis in this disease is not well-recognized. Here, we report a patient with relapsing MOG-Ab disease who presented clinically and radiologically with a relapsing lumbosacral myeloradiculopathy. This presentation raises the diagnostic possibilities of chronic infections, sarcoidosis, and neoplastic infiltration. This case illustrates the need to consider MOG-Ab disease as one of the differential diagnosis for a non-compressive lumbosacral myeloradiculopathy.
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http://dx.doi.org/10.1177/1352458519840747DOI Listing
April 2020

Clinico-radiological correlation and surgical outcome of idiopathic spinal cord herniation: A single centre retrospective case series.

J Spinal Cord Med 2021 May 14;44(3):437-441. Epub 2019 Mar 14.

Department of Neurology, SCTIMST, Trivandrum, India.

Idiopathic spinal cord herniation (ISCH) remains an obscure, under recognised but potentially treatable entity among the etiologies of compressive myelopathy. Here, we present a retrospective case series of eight patients of ISCH with their clinical features, imaging findings and long-term follow up data along with a relevant review of the literature. Mean age at presentation was 36 years with the duration of symptoms ranging from two months to more than thirty years. Contrary to existing data, only two patients in our series had the classical presentation of Brown-Sequard syndrome ( = 2). The clinical spectrum of the presentation was broad with pure spastic quadriparesis ( = 3), girdle sensation ( = 1) and radiculopathy ( = 1), the latter presentation has been unreported for ISCH. The typical radiological picture was seen in all patients. All except one patient was managed conservatively. In the one patient who underwent bilateral dentate ligament excision, there was mild functional improvement on long-term follow-up despite a definite worsening of the radiological picture. Five of the patients had a long-term follow-up with no clinically or functionally significant worsening. The current study highlights the wide clinical spectrum and relatively stable natural course of ISCH and reports on hitherto undescribed presentation as radiculopathy.
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http://dx.doi.org/10.1080/10790268.2019.1579986DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8081328PMC
May 2021

Pregnancy-associated respiratory failure in muscle specific kinase congenital myasthenic syndrome.

Muscle Nerve 2019 04 22;59(4):E24-E26. Epub 2019 Jan 22.

Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.

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http://dx.doi.org/10.1002/mus.26410DOI Listing
April 2019

Maintenance of Normoglycemia May Improve Outcome in Acute Ischemic Stroke.

Ann Indian Acad Neurol 2017 Apr-Jun;20(2):122-126

Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.

Introduction: Several studies have shown that high admission glucose is associated with poor outcomes after stroke, but the impact of maintenance of normoglycemia on functional outcome during hospitalization for acute ischemic stroke is less well established.

Aims: The aim of this study was to examine the independent association of postadmission glycemic status in the 1 week with 3-month functional outcome in patients with acute ischemic stroke.

Methods: Patients with acute ischemic stroke admitted within 48 h of symptom onset with National Institutes of Health Stroke Scale (NIHSS) of ≥4 were selected from a prospectively maintained database by chart review. Demographic data, risk factors, NIHSS, and blood glucose values in the 1 week were collected. The primary outcome was Modified Rankin Scale (mRS) score at 3 months (good outcome-mRS ≤2).

Results: Over 3 years, 342 patients were enrolled with 220 (64.32%) males. Mean age was 60.5 ± 13.4 years, and median admission score on NIHSS was 10 (interquartile range: 6-16). Blood glucose values persistently <140 mg/dl in the 1 week were associated with a good 3-month functional outcome in univariate analysis ( = 0.036). Hypoglycemic episodes occurred only in 11 (3.22%) patients.

Conclusions: Blood glucose values persistently below 140 mg/dl in the 1 week after acute ischemic stroke were associated with a favorable outcome in our study. Future clinical trials are needed to confirm these findings.
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http://dx.doi.org/10.4103/0972-2327.194301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470167PMC
June 2017

Persistent post-stroke dysphagia treated with cricopharyngeal myotomy.

Ann Indian Acad Neurol 2016 Apr-Jun;19(2):249-51

Department of Neurology, Comprehensive Stroke Care Program, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.

Post-stroke dysphagia is a common problem after stroke. About 8-13% patients have persistent dysphagia and are unable to return to pre-stroke diet even after 6 months of stroke. Use of percutaneous endoscopic gastrostomy (PEG) may be required in these patients, which may be psychologically unacceptable and impair the quality of life. In those with cricopharyngeal dysfunction leading on to refractory post-stroke dysphagia, cricopharyngeal myotomy and injection of botulinum toxin are the treatment options. We present a case of vertebrobasilar stroke who had persistent dysphagia due to cricopharyngeal dysfunction with good recovery of swallowing function following cricopharyngeal myotomy 1.5 years after the stroke.
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http://dx.doi.org/10.4103/0972-2327.160055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4888691PMC
June 2016

Metabolic syndrome in young adults with epilepsy.

Seizure 2016 Apr 5;37:61-4. Epub 2016 Mar 5.

Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India. Electronic address:

Purpose: Persons with epilepsy have higher cardiovascular mortality and morbidity compared to general population and alteration of their biochemical milieu is one of the proposed mechanisms. We aimed to study the prevalence of metabolic syndrome and cardiovascular risk factors in young adults with epilepsy and the association with antiepileptic drug use.

Method: An observational study was conducted in persons with epilepsy aged 20-49 years using antiepileptic drugs regularly for the previous three years. The subjects were examined and their blood samples were collected for fasting blood glucose and lipid profile.

Results: Over 18 months, 183 patients (120 males; 63 females) were recruited (mean age 32.5 ± 8.9 years). Metabolic syndrome (MetS) by ATP III criteria was present in 54 (29.5%) subjects. People with MetS in our group had higher frequency of abdominal obesity (50.0%) and hypertriglyceridemia (55.5%) than diabetes/impaired fasting glucose (27.8%). Older age (p=0.005) and use of valproate (p=0.012) were associated with significant risk of MetS.

Conclusion: Clinicians need to be vigilant regarding the risk of MetS while initiating treatment and following up persons with epilepsy.
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http://dx.doi.org/10.1016/j.seizure.2016.03.002DOI Listing
April 2016

Autoimmune encephalitis: Clinical diagnosis versus antibody confirmation.

Ann Indian Acad Neurol 2015 Oct-Dec;18(4):408-11

Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.

Context: Autoimmune encephalitis is a heterogeneous disorder which is being diagnosed with increasing frequency. The diagnosis of these disorders is based on the detection of autoantibodies and characteristic clinical profiles.

Aims: We aimed to study the antibody profile in encephalitis patients with suspected autoimmune etiology presenting to a tertiary care center.

Settings And Design: The subjects were selected by screening all patients with clinical profile suggesting autoimmune encephalitis admitted in the neuromedical intensive care unit (ICU) of a tertiary care center in South India.

Materials And Methods: Patients who fulfilled modified Zuliani et al.'s, criteria for autoimmune encephalitis were identified during the period December 2009-June 2013. Blood samples from these subjects were screened for six neuronal antibodies.

Statistical Analysis Used: Chi-square test was applied to compare the antibody positive and negative patients.

Results: Out of 1,227 patients screened, 39 subjects (14 males: 25 females) were identified with a mean age of 15.95 years and 19 cases were assessed in the acute and 20 in the convalescent phase of the illness. Seizure (87.8 %) was the most common presenting symptom; status epilepticus occurred in 23 (60.5%) patients during the course of the illness. Fourteen (35.9%) patients were N-methyl-D-aspartate receptor (NMDAR) antibody-positive and all were negative for the other antibodies tested.

Conclusions: One-third of patients presenting with acute noninfective encephalitis would be positive for NMDAR antibodies with the remaining two-thirds with clinically suspected autoimmune encephalitis being antibody-negative. There are few markers in the clinical and investigative profiles to distinguish antibody-positive and -negative patients.
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http://dx.doi.org/10.4103/0972-2327.165454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4683878PMC
December 2015

Rapidly progressive dementia, parkinsonism and myoclonus: an unusual presentation of dural arteriovenous fistula.

Neurol India 2014 Jan-Feb;62(1):107-10

Department of Neurology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India.

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http://dx.doi.org/10.4103/0028-3886.128360DOI Listing
May 2014

Tumefactive demyelinating lesions: a clinicopathological correlative study.

Indian J Pathol Microbiol 2012 Oct-Dec;55(4):496-500

Department of Pathology, Sree Chitra Tirunal Institute of Medical sciences and Technology, Trivandrum, Kerala, India.

Tumefactive demyelinating (TDL) lesions are focal zones of demyelination in the central nervous system and they often mimic the neuroimaging features of an intraxial neoplasm. In this report we describe the clinical, neuroimaging and neuropathological features of six cases of TDL. Only in two patients the neuroimaging features in MRI (magnetic resonance imaging) scans were suggestive of TDL while in the other four cases a diagnosis of glioma was suggested. In order to establish a confirmatory diagnosis neuronavigation/stereotactic biopsy was undertaken and the diagnosis of TDL was established in all six cases at histopathology. Two out of six patients did not respond to the conventional corticosteroid therapy and they were treated with plasma exchange. It is being concluded that neuronavigation biopsy, though provide only a small amount of tissue, and is extremely useful in making the diagnosis of TDL.
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http://dx.doi.org/10.4103/0377-4929.107788DOI Listing
November 2013