Journal of Neurology and Neuroscience

Journal Information
ISSN / EISSN : 2171-6625 / 2171-6625
Published by: Scitechnol Biosoft Pvt. Ltd. (10.21767)
Total articles ≅ 326
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, Javeed Ahmed Dar, Abubaker Abdulrahman Almadani
Journal of Neurology and Neuroscience, Volume 10; https://doi.org/10.21767/2171-6625.1000281

Abstract:
Background: Myasthenia Gravis (MG) is an autoimmune disease of the neuromuscular junction. Like any other autoimmune disorder, it can flare up owing to certain predisposing factors, causing severe symptoms, named myasthenia crisis. Aim: The aim of this study is to ascertain any relation of variability of Myasthenia auto-antibodies to myasthenia clinical features especially crisis. Methods: It is a cross sectional study, carried out in Rashid Hospital, Dubai. MG patients between 2004-2010 were recruited and followed for minimum 5 years period. Relationship between disease severity, diversity, immunology and other variables was made through chisquare test mainly. Result: A total of 143 patients were included in the study and 102 completed the follow up. Females predominated in number and their onset was relatively earlier than males (p<0.001). Total 58.8% of patients (67% AchR-Ab+ patients, all MuSK-Ab+ and 33% of seronegative) experienced crisis. Seropositive patients had 30% more tendency to develop crisis (p<0.05). Moreover, myasthenia crisis directly proportional to disease severity at presentation. Conclusion: Seropositive MG is severe form of MG and further in this group MuSK-Ab MG showed higher MGFA grading at presentation and more frequent MG crisis. seronegative patients develop crisis at relatively late age. Seropositivity, mechanical ventilation, old age and high starting MGFA grade indicated poor outcome after crisis.
, Anuradha Batra, Ankita Sharma
Journal of Neurology and Neuroscience, Volume 10; https://doi.org/10.21767/2171-6625.1000282

Abstract:
Spinal generated movement disorders are uncommon. An elderly gentleman presented with distressing jerks of both lower limbs which caused him much social embarrassment. He had received psychiatric treatment for these abnormal muscular spasms without relief. He had become depressed and withdrawn when he first presented to our outpatient department. A routine clinical examination followed by a long-term video EEG with simultaneous EMG clinched the diagnosis of a spinal segmental myoclonus. He underwent spinal decompression surgery with fixation followed by treatment with levetericetam and clonazepam which relieved his symptoms. Spinal generated movement disorders are uncommon and are often attributed to a psychiatric disorder in the absence of a better explanation. We take this opportunity to elaborate on the case details, investigations and the treatment of spinal myoclonus.
Steven Benvenisti
Journal of Neurology and Neuroscience, Volume 10; https://doi.org/10.21767/2171-6625-c1-019

Abstract:
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Sergey A Dzugan
Journal of Neurology and Neuroscience, Volume 10; https://doi.org/10.21767/2171-6625-c1-020

Abstract:
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, Gonthong A, Wongsripuemtet J, Charnchaowanish P, Chawalparit O, Muangpaisan W, Witthiwej T
Journal of Neurology and Neuroscience, Volume 10; https://doi.org/10.21767/2171-6625.1000283

Abstract:
Purpose: The clinical and imaging findings of idiopathic normal pressure hydrocephalus (iNPH) and Alzheimer's disease (AD) patients have some overlap and are often challenging to diagnose. The fornix is an important structure in the memory function, and damage to the fornix can result in memory impairment. Our study aimed to explore any differences in the microstructural changes to the fornices of iNPH and AD patients relative to those of normal control subjects, as demonstrated by using diffusion tensor imaging (DTI). Materials and methods: Ten normal control subjects, 10 iNPH patients and 10 AD patients underwent MRI scans (3-Tesla), and the DTI data were obtained. The DTI parameters and the diffusion fiber tractography were derived using DSI studio software. The differences in the fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusivity, and radial diffusivity data of the three groups were compared. A receiver operating characteristic (ROC) curve analysis was also evaluated. Results: There was a statistically-significant lower mean FA for the iNPH and AD patients than the normal control subjects. The mean ADC of the iNPH patients was statistically significantly higher than that of both the normal control subjects and the AD patients. The mean ADC is probably the most helpful parameter evident from our results, given its high sensitivity and high negative predictive value for discriminating between iNPH and AD patients. Conclusion: Our study revealed different microstructural changes in the fornices of iNPH and AD patients using the DTI technique. The results are probably due to differences in the pathogenesis of the diseases. Furthermore, our study demonstrated the possibility of using the DTI parameter as a supportive tool to discriminate between iNPH and AD patients with high sensitivity and a high negative predictive value.
Ram Sagar, Amit Kumar, Shubham Misra, Pradeep Kumar, Ritesh Raj, Arti Gulati, Kameshwar Prasad
Journal of Neurology and Neuroscience, Volume 10; https://doi.org/10.36648/2171-6625.10.2.297

Abstract:
Objective: Present study was taken up to establish the association between CYP4F2 G1347A polymorphism and risk of ischemic stroke (IS) in a North Indian population. Methods: In a hospital-based case-control study, 250 cases and 250 age and sex matched control subjects were recruited from Outpatient Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. Polymerase chain reaction – Restriction fragment length polymorphism (PCR-RFLP) was used for genotyping. Data were analyzed using STATA software, Version 13. Results: The mean age of IS patients were 52.83 ± 12.59 years and in control group were 50.97 ± 12.70 years. Genotypic frequency distributions were in accordance with Hardy Weinberg Equilibrium (HWE) in both cases and controls. Conditional logistic regression analysis showed an independent association between CYP450 G1347A gene polymorphism with the risk of IS under dominant model (OR 2.05; 95% CI 1.18 to 3.56). Analysis based on Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification discerned a significant association with Large Vessel Disease (LVD) subtype of IS in both the unadjusted (OR, 2.5; 95% CI 1.49 to 4.20) and adjusted (OR, 3.32; 95% CI 1.72 to 6.43) analysis and a significant association with Small Vessel Disease (SVD) subtype of IS after the adjusted analysis (OR, 2.43; 95% CI 1.14 to 5.16) under recessive model. Conclusion: Present study suggests that CYP4F2 G1347A polymorphism may be an important risk factor for IS mainly for LVD subtype of IS. Prospective studies with large sample size are needed to confirm the present findings.
, Jordi Rumia, Shigeru Fukutake, Kazuaki Yamamoto, Toshio Yamaguchi, Takaomi Taira, Tetsumasa Kamei
Journal of Neurology and Neuroscience, Volume 10; https://doi.org/10.36648/2171-6625.10.2.293

Abstract:
Background: Skull density ratio (SDR) is one of the key factors for the success of MRI-guided focused ultrasound (MRgFUS) treatment for brain diseases. We examined the efficacy of alendronate (Aln) to improve a SDR value. Materials and Methods: The subjects were 6 Parkinson’s disease patients (2 men, 4 women, 70.7 ± 7.7 years old) and 1 essential tremor patient (1 man, 81 years old). Despite of desire to MRgFUS treatment, we could not schedule their treatments because their SDR values were too low. As they coexisted with untreated osteoporosis, we administered 35 mg of Aln weekly and followed their SDR values every 3 months. Results: The SDR value elevated in 4 patients following the administration of Aln and we could perform MRgFUS treatment successfully. No adverse reactions related with Aln were observed. Conclusion: Although it will take several months, Aln may be a useful option for MRgFUS candidates with a low SDR value.
, Alexandra Gerasimova, Ze’Ev Itsekson, Noit Brown, Yvonne Schwammenthal, Oleg Merzlyak, Mati Bakon, David Orion
Journal of Neurology and Neuroscience, Volume 10; https://doi.org/10.36648/2171-6625.10.2.295

Abstract:
Introduction: Systemic Thrombolysis with tissue Plasminogen Activator (tPA) has been an established therapy for ischemic stroke for more than 20 years, with limited effect on large vessel occlusions. New catheter-based techniques allow high revascularization rates were tPA fails. Systemic thrombolysis remains the standard treatment of care and endovascular treatment is newly established as therapy for large vessel occlusion or rescue therapy after unsuccessful revascularization by thrombolysis. Patients with large vessel occlusions have a very limited reperfusion rate and benefit from direct endovascular treatment (EVT). In this real-life study, patients are compared regarding their outcome after systemic thrombolysis with rescue endovascular treatment in comparison to direct endovascular treatment for large vessel occlusions. Patients and Methods: Patients are categorized retrospectively by their treatment. Data on 120 patients was used, with the exclusion of 13 patients. Analyses were performed according to mRS and EQ5D after 7 days as well as 10 to 14 weeks. Primary observed outcome was quality of life and mRS after 10 to 14 weeks. Results: Regarding mRS, initial outcome after 7 days is more successful with direct EVT, but prior thrombolysis shows additional improvement after 10 to 14 weeks. There is no statistically relevant difference in patients that received prior tPA and rescue endovascular treatment in comparison to direct endovascular treatment after 10 to 14 weeks. EQ5D on the other hand shows higher life quality, according to better functional outcome after endovascular treatment. Regarding the primary endpoint of the study, there is no statistically relevant difference between both study groups at the end point of the study. Discussion: While direct endovascular treatment shows an immediate benefit for patients with large vessel occlusions, over the time course of 10 to 14 weeks there is a higher additional benefit for prior thrombolysis treatment. Regarding that, both treatment arms show a similar outcome. A higher life quality regarding EQ5D is archived after direct EVT while judgement for general ability is rated higher with additional tPA treatment. Conclusion: In this mono-center study it was shown that patients eligible for thrombolysis with large vessel occlusions should receive tPA if eligible. By lack or insufficient improvement, a rescue endovascular treatment should be applied. Direct endovascular treatment shows a similar outcome regarding mRS but a higher life quality index.
Maimoona Siddiqi, Qamar Zaman, Nadia Mehboob, Salman Mansoor
Journal of Neurology and Neuroscience, Volume 10; https://doi.org/10.36648/2171-6625.10.4.303

Abstract:
Introduction: An important issue in female patients with epilepsy is the effects of Epilepsy and AEDS on both the mother and fetus with various complications during pregnancy and peripartum period. Pregnancy may also affect the seizure control in variable ways. In order to address these issues large national and multinational registries are required especially in developing world. Purpose of this registry is to collect local demographics and also plan the strategies required for the improvement in reproductive health services. Methodology: This is a prospective, cross-sectional, observational ongoing analysis, with follow up of pregnant women with epilepsy (WWE) who presented in neurology outpatient clinic. The demographic data on disease and the AEDS were recorded in a structured Performa. Data was analyzed using standard statistical software SPSS version 20. Results: There were 65 patients with mean age 27.5 ± 5.02. Most common diagnosis was IGE followed by genetic focal epilepsy. Most common Maternal complications was vaginal bleed (n=6) followed by abortion, hyperemesis gravidarum eclempsia, oligohydromnias (n=1) each. Fetal distress was observed in 3 cases, and 1 case of each of the premature birth, IUGR, IUD and CDH were seen. Most common drug used was Lamotrigene followed by Levateracetem while polytherapy was used by 15 patients. Conclusion: Awareness about the impact of epilepsy and AEDs on the maternal and fetal outcomes in pregnancy is important. Improvement in reproductive health services in such patients with good liaison between neurology and obstetrical department should be emphasized to improve the outcome.
, Ai Seki, Shigeru Fukutake, Sanae Odake, Terunori Sano, Yuji Uchida, Hiroshi Kitahara, Tetsumasa Kamei
Journal of Neurology and Neuroscience, Volume 10; https://doi.org/10.36648/2171-6625.10.4.300

Abstract:
A 78-year-old man suddenly developed a severe occipital headache, followed by right greater occipital neuralgia (ON). Brain MR imaging revealed a spinal cord infarction in the territory of the right posterior spinal artery (PSA) at the C2 level without vertebral artery (VA) dissection. Even without VA dissection, upper cervical PSA syndrome could cause severe occipital headache. Furthermore, ipsilateral ON could follow it. The present case suggests that severe occipital headache and ON can occur in a patient with upper cervical PSA syndrome without VA dissection.
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