Annals of Indian Academy of Neurology最新文献

{"title":"Polyneuropathy due to n-Hexane Intoxication - A Case Series.","authors":"Khichar P Shubhakaran, Pradeep Lalwani, Nidhi Yadav","doi":"10.4103/aian.aian_39_25","DOIUrl":"https://doi.org/10.4103/aian.aian_39_25","url":null,"abstract":"<p><strong>Abstract: </strong>n-Hexane, a volatile organic chemical, is notorious for its neurotoxicity in occupational settings. We present four patients working in a needle manufacturing factory who presented with polyneuropathy after exposure to n-hexane by inhalation. Cerebrospinal fluid showed albuminocytological dissociation. Nerve conduction study (NCV) showed primary demyelination with secondary axonal polyneuropathy. Excluding the other possible causes, the diagnosis of n-hexane neuropathy was kept. Patients were managed with symptomatic treatment and showed marked improvement in 6-month follow-up.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy of Anti-amyloid Monoclonal Antibodies in Early Alzheimer's Dementia: A Systematic Review.","authors":"Alyaa Mostafa, Stephanie Tiu, Farooq Khan, Nusrath A Baig","doi":"10.4103/aian.aian_547_24","DOIUrl":"https://doi.org/10.4103/aian.aian_547_24","url":null,"abstract":"<p><strong>Introduction: </strong>Much research has been conducted into the role and safety of anti-amyloid monoclonal antibodies on the progression of Alzheimer's disease (AD). Despite the historical approval of three drugs by the US Food and Drug Administration for the treatment of early AD, there remains other potential treatment, which is yet to be approved or further developed. This systematic review explores the efficacy of anti-amyloid monoclonal antibodies in the treatment of early AD from reported clinical trials.</p><p><strong>Methods: </strong>Authors conducted a systematic search of MEDLINE and Embase. Screening was carried out by two authors and cross-checked thereafter. Clinical changes in cognition and objective measures such as cerebrospinal fluid biomarkers and imaging constituted primary and secondary outcomes, respectively.</p><p><strong>Results: </strong>Our search yielded 14 randomized controlled trials; the primary focus of the included trials is amyloid-β. The monoclonal antibodies reported in this review are: lecanemab, aducanumab, crenezumab, solanezumab, donanemab, bapineuzumab, and gantenerumab. The most common finding among the trials is the lack of statistically significant results in measures of clinical outcomes, (e.g., Clinical Dementia Rating Scale-Sum of Boxes, AD Assessment Scale-Cognitive Subscale). However, specific trials investigating lecanemab, aducanumab, and donanemab demonstrated promising improvements in clinical cognition. Results related to secondary outcomes were also mixed, but showed more positive findings across the included trials. Overall, primary outcomes were inconsistent with secondary outcomes.</p><p><strong>Conclusion: </strong>Our findings highlight the need to consider the complex pathophysiology of AD in treatment development. Focusing solely on the amyloid-beta hypothesis may be inadequate; further research is necessary to understand the underlying mechanisms and develop treatments for the multifactorial nature of the disease.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic Sketch of Parkinson's Disease in India.","authors":"Suvorit S Bhowmick, Soaham D Desai","doi":"10.4103/aian.aian_1021_24","DOIUrl":"https://doi.org/10.4103/aian.aian_1021_24","url":null,"abstract":"<p><strong>Abstract: </strong>By the current estimates, India is likely to face an alarmingly high burden of Parkinson's disease (PD) in the next two decades. Untangling the pathophysiology of PD through genetic research is the key to precision medicine and prevention strategies. This narrative review serves dual purpose of recapitulating phenomenology of monogenic diseases presenting with parkinsonism and synthesizing knowledge on PD genetics gained through research in India over the past two decades. Recent studies have detected rare genetic variants in 15%-20% of the early-onset PD patients in India. Due to lack of segregation analysis and functional validation, a vast majority of these remain as variants of uncertain significance. Nevertheless, several potentially pathogenic variants detected in the Indian PD patients are not yet cited in the global genetic databases such as Movement Disorder Society Genetic mutation database. Biallelic mutations (pathogenic single-nucleotide variants and copy number variants) in the PRKN gene account for 3%-5% of monogenic early-onset PD in the Indian population. About 2%-3% of the Indian EOPD patients carry pathogenic variants in the genes associated with atypical parkinsonism, such as PLA2G6, suggesting that initially, they may be indistinguishable from monogenic PD. Up to 10% of the PD patients in India carry heterozygous pathogenic variants in GBA1, a risk factor gene. Genetic research in India has several critical gaps, such as uneven geographic or ethnic representation, discrepancies in variant classification, and lack of large-scale genome-wide association studies. Sustained nationwide as well as international collaborative efforts are needed to bridge these gaps and foster translational science.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SPRINT INDIA: Regional Variations in Primary and Secondary Stroke Outcomes Based on Baseline Characteristics in North and South Indian Sites.","authors":"Somasundaram Kumaravelu, Shweta Jain Verma, Rimpi Arora, Deepti Arora, Ks Arya Devi, Aneesh Dhasan, Padmavathyamma Narayanapillai Sylaja, Dheeraj Khurana, Pamidimukkala Vijaya, Biman Ray, Vivek Nambiar, Sanjith Aaron, Gaurav Mittal, Sundarachary Nagarjunakonda, Aparna Pai, Yerasu Muralidhar Reddy, Sunil Narayan, Nomal Borah, Rupjyoti Das, Girish Kulkarni, Vikram Huded, Thomas Mathew, Madakasira Vasantha Padma Srivastava, Rohit Bhatia, Pawan Ojha, Jayanta Roy, Sherly Abraham, Anand Vaishnav, Arvind Sharma, Shaikh Afshan Jabeen, Abhishek Pathak, Sanjeev Bhoi, Sudhir Sharma, Sulena Sulena, Aralikatte Onkarappa Saroja, Neetu Ramrakhiani, Madhusudhan Byadarahalli Kempegowda, Sankar Gorthi, Mahesh Kate, Tina George, Ivy Sebastian, Meenakshi Sharma, Rupinder Dhaliwal, Rahul Huilgol, Jeyaraj Durai Pandian","doi":"10.4103/aian.aian_792_24","DOIUrl":"https://doi.org/10.4103/aian.aian_792_24","url":null,"abstract":"<p><strong>Background and objectives: </strong>Regional differences in stroke prevalence and outcomes in India, driven by demographic and risk factors, are crucial for guiding effective prevention and management strategies. This subanalysis of Secondary prevention with a structured semi-interactive stroke prevention package in INDIA (SPRINT INDIA) randomized controlled trial compared the demographics, risk factors, and clinical outcomes of stroke patients from North and South India to identify regional differences and inform targeted interventions for stroke prevention.</p><p><strong>Methods: </strong>The study analyzed data of 4298 participants from 31 stroke centers across India, focusing on demographics, stroke types, and risk factors. In this study, Mumbai, located at 19.07°N in western India, serves as the dividing line between North and South India. One-year follow-up data from 3038 patients were utilized to examine regional disparities between North and South India.</p><p><strong>Results: </strong>South Indian stroke patients were predominantly rural (60.1%) and less educated (58.2%), while North Indian patients were mostly urban (64.2%). South Indian patients had higher incidence of ischemic stroke (91.1% vs. 73.5%, P = 0.001) and higher rates of large artery atherosclerosis (33.6% vs. 19.7%, P = 0.001), hypertension, type 2 diabetes, smoking, and alcohol consumption, but better medication adherence. In contrast, North Indian patients had higher high-density lipoprotein, drug use, and tobacco use. At 1-year follow-up, North Indian patients had more high-risk transient ischemic attacks and poorer lifestyle-related outcomes, despite South Indians having higher systolic blood pressure and fasting glucose levels.</p><p><strong>Conclusion: </strong>Region-specific strategies are crucial. Block randomization may help. South India needs better lifestyle modification programs, while North India requires improved health education and medication adherence strategies.Trial registration: CTRI/2017/09/009600.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal Systolic Blood Pressure Control After Thrombectomy in Acute Ischemic Stroke: A Systematic Review and Meta-analysis.","authors":"Baikuntha Panigrahi, Rohit Bhatia, Partha Haldar, Risha Sarkar, Imnameren Longkumer","doi":"10.4103/aian.aian_1087_24","DOIUrl":"https://doi.org/10.4103/aian.aian_1087_24","url":null,"abstract":"<p><strong>Background and objectives: </strong>The optimal systolic blood pressure (SBP) control after endovascular thrombectomy (EVT) is unclear. This study aimed to determine whether intensive SBP control (<140 mmHg) within 24 h post-EVT, compared to conventional management (<180 mmHg), leads to a better functional outcome, defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we searched databases (PubMed, Scopus, EMBASE, Google Scholar, Web of Science) for English language articles up to March 15, 2024. We included randomized controlled trials (RCTs) and observational studies comparing intensive versus conventional SBP control up to 24 h post-EVT. Studies without separate primary outcome data and case series/reports were excluded. The primary outcome was functional independence (mRS 0-2 at 90 days).</p><p><strong>Results: </strong>Twelve studies (n = 5152 patients; five RCTs and seven observational studies) were included, and a primary analysis of the RCTs, along with a secondary exploratory analysis of the observational studies were conducted. The analysis of RCTs favored conventional control for the primary outcome (risk ratio [RR]- 0.81; 95% confidence interval [CI]- 0.73-0.90; P < 0.0001). Mortality rates (RR- 1.14, 95% CI- 0.89-1.45; P = 0.29) and the risk of symptomatic intracranial hemorrhage (RR- 1.10, 95% CI- 0.77-1.58; P = 0.60) were similar in both groups. The secondary exploratory analysis of observational data favored the intensive arm for the primary outcome (RR- 1.28, 95% CI- 1.17-1.41; P < 0.00001).</p><p><strong>Conclusions: </strong>Our primary analysis of RCTs showed that intensive control was associated with poorer functional outcomes, with no significant impact on mortality rate or the risk of symptomatic intracranial hemorrhage. Although observational studies suggested better outcomes with intensive control, we recommend conventional management based on Level 1 evidence from RCTs.PROSPERO Registration no- CRD42023463173.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spectrum of Neurological Manifestations of HHV-6 Encephalitis in Immunocompetent Children - A Retrospective Study at a Tertiary Care Center in South India.","authors":"Dona T Thomas, Kalpana Devadathan, Greeshma Baby, Mohammed Pa Kunju, Prameela Joji","doi":"10.4103/aian.aian_717_24","DOIUrl":"https://doi.org/10.4103/aian.aian_717_24","url":null,"abstract":"<p><strong>Background: </strong>Human Herpes Virus 6 (HHV6) can cause severe neurological manifestations in immunocompromised individuals. However, there is sparse data regarding this in immunocompetent children.</p><p><strong>Objective: </strong>To describe the spectrum of neurological manifestations of HHV 6 infection and outcome in immunocompetent children admitted with suspected meningoencephalitis from January 2017 to December 2023.</p><p><strong>Methodology: </strong>We retrospectively analysed the electronic medical records of children admitted for suspected meningoencephalitis in a tertiary care Pediatric Neurology centre in South India. The children whose cerebrospinal fluid (CSF) was found to be positive for HHV6 DNA in film array meningoencephalitis (FA -ME) panel were included.</p><p><strong>Results: </strong>204 /416 children with suspected meningoencephalitis were included in the study. HHV 6 was detected in 12 children. The median age was 19 months (Range - 6 months to 16 years). 4 (33%) of them were classified as febrile status. 5 (42%) children had meningoencephalitis, and one had aseptic meningitis. One child each had features of probable acute demyelinating encephalo myelitis (ADEM) and anti NMDA receptor encephalitis. 9 (75%) children had uneventful clinical recovery, one child died, one child with probable ADEM had extrapyramidal signs at discharge, which improved completely at one year follow up and the baby with autoimmune encephalitis had significant neurological deficits.</p><p><strong>Conclusion: </strong>HHV 6 can cause significant neurological problems, with significant morbidity and mortality in immunocompetent children also.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Supratentorial Lymphocytic Inflammation with Parenchymal Perivascular Enhancement Responsive to Steroids (SLIPPERS) with Associated Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids (CLIPPERS) and a Review of Literature.","authors":"Shivam Mirg, Animesh Das, Akhil Parashar, Manjari Tripathi, Ajay Garg","doi":"10.4103/aian.aian_998_24","DOIUrl":"https://doi.org/10.4103/aian.aian_998_24","url":null,"abstract":"","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-Depth Understanding of Hirayama Disease: Dural Detachment Beyond Cervical Spine.","authors":"Seena Vengalil, Vijaykumar Boddu, Karthik Kulanthaivelu, Dipti Baskar, Saraswati Nashi, Nupur Pruthi, Hemant Bhargav, Alok M Uppar, Chandrajit Prasad, Madhulika Kotra, Kiran Polavarapu, Veeramani Preethish-Kumar, Atchayaram Nalini","doi":"10.4103/aian.aian_16_25","DOIUrl":"https://doi.org/10.4103/aian.aian_16_25","url":null,"abstract":"<p><strong>Background and objectives: </strong>Hirayama disease (HD) is a cervical flexion-induced compressive myelopathy. Typically, there is forward displacement and loss of attachment of dural sac to lamina at the cervical level during neck flexion. However, the extent of the dural detachment (DD) has not been studied carefully. We undertook this study to know the extent of DD in HD.</p><p><strong>Methods: </strong>We conducted a retrospective study of HD patients evaluated from 2015 to 2023. Patients with DD extending beyond the cervical spine were selected, and their clinical and radiological features were studied.</p><p><strong>Results: </strong>One hundred and thirty-two (62.8%) patients were identified to have DD beyond the cervical spine in a cohort of 210 HD patients. The mean age at onset and duration were 18.09 ± 2.3 years (13-26) and 38.63 ± 39.9 months, respectively. Proximo-distal involvement was noted in 50% of patients, while 33% and 17% of patients had isolated distal and proximal involvement, respectively. Wasted legs were observed in three patients. Cord atrophy was present in 96.9% of patients, extending from C5 to C7. Epidural detachment and engorgement of posterior epidural venous plexus were evident in all. DD extended from C2 to D10 vertebral level. The cranial extent of DD was from C2 to C4 in 87% of cases, and the caudal extent was D1-D5 in 84% of cases, extending up to D10 in two cases.</p><p><strong>Conclusions: </strong>The HD spectrum continues to evolve phenotypically and radiologically. The pathophysiological mechanisms and DD extend beyond the cervical spine in a large proportion of patients. This makes it important to cover a longer part of the spine during imaging. This may have implications on the management of patients, particularly those with isolated lower limb involvement.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phenotypic Variations in Clinical Presentations of Paramyotonia Congenita in Two Brothers.","authors":"Kamalesh Tayade, Vishakha Ghadi, Dynaneshwar Asole, Haresh Bharote, Anil Venkatachalam","doi":"10.4103/aian.aian_1070_24","DOIUrl":"https://doi.org/10.4103/aian.aian_1070_24","url":null,"abstract":"","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Expanding Spectrum of Anti-IgLON5 Disease: A Case Series from an Indian Cohort.","authors":"Avinash Ganapule, Divyani Garg, Ayush Agarwal, Anu Gupta, Roopa Rajan, Soaham Desai, Mitesh Chandarana, S Sidharth, Madhavi Tripathi, Ajay Garg, Divya M Radhakrishnan, Achal Kumar Srivastava","doi":"10.4103/aian.aian_1073_24","DOIUrl":"https://doi.org/10.4103/aian.aian_1073_24","url":null,"abstract":"<p><strong>Abstract: </strong>Anti-IgLON5 disease is an evolving entity that lies at the confluence of autoimmunity and neurodegeneration. Reports from India remain sparse. In this series, we describe seven Indian patients with anti-IgLON5-related disease. Patients presented across the fifth to eighth decades with a mean duration of illness of 16 months. All had movement disorders, which included gait ataxia, parkinsonism, and chorea. Six patients had sleep disturbances. Five had a frontal dysexecutive dementia phenotype. Two had epilepsy. Bulbar involvement was present in four, and one had amyotrophic lateral sclerosis (ALS)-like features. Magnetic resonance imaging was abnormal in two cases. Positron emission tomography of the brain also contributed to diagnosis. Combination immunotherapies were used in most of the patients, with three showing a sustained response and two deaths reported due to sepsis-related complications. It is important to recognize the increasing spectrum of IgLON5-related disease to enable timely initiation of immunotherapy before marked degeneration occurs.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}