Annals of Indian Academy of Neurology最新文献

{"title":"A Retrospective, Single-Arm, Observational Study in Patients with Multiple Sclerosis in India Receiving Ocrelizumab Therapy for 1 Year.","authors":"Mv Padma Srivastava, Joy Dev Mukherji, Anshu Rohatgi, Sameer Arora","doi":"10.4103/aian.aian_165_26","DOIUrl":"10.4103/aian.aian_165_26","url":null,"abstract":"<p><strong>Background and objectives: </strong>Ocrelizumab is an established therapy for multiple sclerosis (MS). However, real-world data from Indian clinical settings remain limited. Hence, the present study was conducted to evaluate the clinical effectiveness, radiological response, and safety profile of ocrelizumab over 12 months of therapy among patients with MS in India.</p><p><strong>Methods: </strong>This retrospective observational study included data from adults diagnosed with multiple sclerosis (MS) who received ocrelizumab for at least 12 months. Clinical, radiological, and safety data were recorded. Primary outcomes were changes in the Expanded Disability Status Scale (EDSS) score and relapse rate. Secondary outcomes included magnetic resonance imaging (MRI) lesion counts and safety events. Statistical comparisons were performed.</p><p><strong>Results: </strong>Fifty-five patients were included with a mean age of 38.2 (8.75) years. 61.8% were female. EDSS scores improved significantly from 3.77 (1.71) at baseline to 3.28 (2.05) at 12 months ( P < 0.001). The annualized relapse rate decreased from 0.60 to 0.15, and MRI analysis showed significant reductions in both T2 lesions (17.06 [12.94] to 1.09 [2.38]; P < 0.001) and gadolinium-enhancing T1 lesions (1.26 [1.17] to 0.06 [0.23]; P < 0.001). Clinically indicated MS-related hospitalizations (excluding all treatment-administration admissions) decreased from 32.7% before treatment to none during the 12-month follow-up. No serious adverse events were reported, and 96.4% of patients experienced no adverse events. Regression analysis identified baseline EDSS as the only independent predictor of disability at 12 months.</p><p><strong>Conclusions: </strong>Twelve months of ocrelizumab therapy was associated with significant reductions in relapse activity and MRI lesion burden, as well as improvement/stabilization of disability, with a favorable safety profile.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"825-832"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787520","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":"Necrotizing Myopathies: A Myopathology Experience from a Single Tertiary Care Center.","authors":"Swetha Sivakumar, Megha Uppin, Reshma Sultana Shaik, Venkata Surya Subbalaxmi Malladi, Sireesha Yareeda, Afshan Jabeen, Sree Bhushan Raju, Muralidhar Reddy","doi":"10.4103/aian.aian_81_26","DOIUrl":"10.4103/aian.aian_81_26","url":null,"abstract":"<p><strong>Background and objectives: </strong>Necrotizing myopathy (NM) is a rare inflammatory myopathy characterized by prominent necrosis and minimal to absent inflammation, arising from heterogeneous immune- and non-immune-mediated causes. Muscle biopsy aids diagnosis, especially in seronegative cases and those with overlapping presentations, helping to distinguish NM from other idiopathic inflammatory myopathies (IIMs). This tertiary center study examines the myopathologic spectrum in NM, correlating histopathologic findings with clinical features and autoantibody profiles.</p><p><strong>Methods: </strong>We studied the records and biopsies of 77 patients diagnosed with NM between June 2023 and December 2024. Clinical and myositis antibody data were obtained from the records. The biopsies underwent histologic evaluation, including enzyme histochemistry and immunohistochemistry. Descriptive statistics and Chi-square tests (GraphPad Prism 9.5.1) were used to assess features across etiologies.</p><p><strong>Results: </strong>This study included 77 patients (median age, 51 years; M:F, 2.4:1) with a mean creatine phosphokinase of 21,230 IU/L. All presented with acute/subacute proximal weakness ( n = 77, 100%), while myalgias ( n = 20, 25%) and fever ( n = 17, 22%) were less common. Identified etiologies included statin-associated myopathy ( n = 19, 24.6%), infections ( n = 22, 28.5%), anti-signal recognition particle myopathy ( n = 7, 9%), anti-hydroxy-3-methylglutaryl-coenzyme A reductase myopathy ( n = 4, 5.1%), others (overlap syndromes, alcohol-related myopathy, lipid storage myopathy, etc.), and idiopathic cases ( n = 15, 19.4%). Biopsy findings included scattered necrotic fibers ( n = 48, 62%), groups of necrotic fibers ( n = 29, 37.6%), fiber regeneration ( n = 52, 67.5%), perivascular inflammation ( n = 11, 14.2%), endomysial inflammation ( n = 4, 5.1%), and major histocompatibility complex class I (MHC-I) expression that was diffuse positive ( n = 22, 28.5%), focal positive ( n = 26, 33.7%), or negative ( n = 19, 24.6%). MHC-I expression significantly discriminated among etiologies ( P = 0.0013), unlike patterns of necrosis or inflammation ( P > 0.20).</p><p><strong>Conclusions: </strong>NM encompasses diverse immune- and non-immune-mediated causes that share similar biopsy features, distinct from those of other inflammatory myopathies. Accurate diagnosis requires clinicoseropathologic correlation.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"780-787"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178404","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":"Open-Loop Deep Brain Stimulation Versus Closed-Loop Responsive Neurostimulation in Drug-Resistant Bitemporal Epilepsy: A Narrative Review.","authors":"Syeda Fatima Zehra, Muhammad A Hassan, Pratiksha Baliga, Atif S Khatib, Faheem Ullah","doi":"10.4103/aian.aian_226_26","DOIUrl":"10.4103/aian.aian_226_26","url":null,"abstract":"<p><strong>Abstract: </strong>Drug-resistant bitemporal epilepsy presents a therapeutic challenge when resective surgery is not feasible due to bilateral seizure onset or eloquent cortex involvement. Neuromodulation has emerged as an alternative, with open-loop deep brain stimulation (DBS) and closed-loop responsive neurostimulation (RNS) as implantable strategies. Comparative indications for modality selection remain unclear. A narrative review of articles published from January 2007 to January 2026 was performed in PubMed/MEDLINE. Approximately 120 articles were screened, and 39 studies were included. Due to heterogeneity in study design, findings were synthesized qualitatively. Both DBS and RNS significantly reduce seizure frequency in drug-resistant bitemporal epilepsy, with a median seizure reduction of approximately 60% to 75%. Seizure freedom, however, remained limited, reflecting the palliative nature of these treatments. Open-loop anterior nucleus of the thalamus (ANT) DBS provides network-level modulation with low maintenance, while hippocampal DBS offers localized temporal inhibition. Conversely, closed-loop RNS delivers adaptive focal stimulation via real-time sensing and yields chronic intracranial electroencephalogram data. While both modalities show comparable efficacy, RNS may be advantageous in focal or asymmetric bitemporal epilepsy. Cognitive outcomes were favorable for both techniques, with RNS demonstrating the prevention of memory and language decline. Both DBS and RNS are palliative neuromodulatory options for patients in whom resective surgery is not feasible. Treatment selection should be individualized based on seizure network characteristics, laterality, monitoring needs, participation capacity, and cognitive considerations. The primary goal is to reduce seizure frequency and improve quality of life rather than to achieve seizure freedom. Future multicenter studies and biomarker-driven strategies are needed to refine selection and improve long-term outcomes.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"697-703"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178601","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":"Atypical Phenotype of Marinesco-Sjögren Syndrome with Predominant Myopathy due to a Novel SIL1 Variant.","authors":"N Aravind Ram, Asish Vijayaraghavan, Kiren G Koshy, Sruthi S Nair, Syam Krishnan","doi":"10.4103/aian.aian_176_26","DOIUrl":"10.4103/aian.aian_176_26","url":null,"abstract":"","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"900-902"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148161640","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":"Ultrasound-Guided Greater Occipital Nerve Pulsed Radiofrequency for Chronic Headache in Adults Aged 65 Years and Older: A Retrospective Cohort Study.","authors":"Sukriye Dadali, Gulcin Babaoglu, Ulku Sabuncu, Ali Costu, Ibrahim Asoglu, Erkan Yavuz Akcaboy","doi":"10.4103/aian.aian_266_26","DOIUrl":"10.4103/aian.aian_266_26","url":null,"abstract":"<p><strong>Background and objectives: </strong>Managing chronic headache in older adults is complicated by multimorbidity and polypharmacy. This study evaluated 6-month clinical outcomes, tolerability, and response predictors following ultrasound-guided greater occipital nerve pulsed radiofrequency (GONPRF) in patients aged ≥65 years.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed 152 patients undergoing ultrasound-guided GONPRF following a positive diagnostic block (≥50% relief). Pain intensity (numeric rating scale, NRS), headache frequency, attack duration (hours), and analgesic use (days/month) were assessed at baseline and 1, 3, and 6 months. The primary endpoint was therapeutic success, defined as a global perceived effect score ≥6 at 6 months. Predictors of response were analyzed via logistic regression. Adverse events were assessed through clinical records and patient interviews.</p><p><strong>Results: </strong>Significant improvements occurred in NRS, headache frequency, attack duration, and analgesic use at all follow-up points ( P < 0.001). Therapeutic success was achieved by 56.6%, 52.6%, and 49.3% of patients at 1, 3, and 6 months, respectively. Outcomes were comparable between proximal and distal techniques. Higher baseline analgesic use was the sole independent predictor of a lower likelihood of treatment success ( P = 0.038, OR = 0.95). Adverse events (18.4%) were mild and resolved within 48 hours.</p><p><strong>Conclusions: </strong>Ultrasound-guided GONPRF was associated with significant improvements and was well-tolerated in this geriatric cohort. However, due to the retrospective design, lack of a control group, and potential selection bias, the findings should be interpreted cautiously.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"818-824"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705181","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":"Prominent Cognitive and Psychiatric Disturbances in Aceruloplasminemia.","authors":"Somdattaa Ray, Thomas Mathew, Vaibhav Bhat, Pritam Mazumdar, Mohammed Shakeebuddin Kashif, Sai Kanth Deepalam, Gg Sharath Kumar","doi":"10.4103/aian.aian_1253_25","DOIUrl":"10.4103/aian.aian_1253_25","url":null,"abstract":"","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"887-889"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705220","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":"Bupivacaine-Induced Chemical Meningitis: An Uncommon Cause of Meningitis Following Spinal Anesthesia - Two Cases.","authors":"Jibu K Jo, Kondanath Saifudheen","doi":"10.4103/aian.aian_118_26","DOIUrl":"10.4103/aian.aian_118_26","url":null,"abstract":"","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"871-873"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786941","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":"Sleep and Migraine Interactions in Episodic and Chronic Migraine: A Hospital-Based Cross-Sectional Study.","authors":"Sahil Mathur, Doniparthi V Seshagiri, Sivasubramaninan Mythirayee, Pooja Mailankody, Pritam Raja, Shaik Ahmed, Binu V Sreekumaran Nair, Nitesh Kamble, Girish B Kulkarni, Ravi Yadav, Sanjib Sinha","doi":"10.4103/aian.aian_433_26","DOIUrl":"10.4103/aian.aian_433_26","url":null,"abstract":"<p><strong>Background and objectives: </strong>Migraine and sleep disturbances frequently coexist. The study aimed at characterizing sleep disturbances and their association with migraine characteristics.</p><p><strong>Methods: </strong>In this cross-sectional study, 253 patients with migraine [patients with episodic migraine (pEM) = 103 and patients with chronic migraine (pCM) = 150] were assessed. Migraine-related disability was measured using the Migraine Disability Assessment (MIDAS). Sleep-related parameters were measured using the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and the Berlin Questionnaire. Depression and anxiety were assessed using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7).</p><p><strong>Results: </strong>Poor sleep quality was found in 18.4% of pEM and 58.7% of pCM. Headache and sleep disturbances frequently coexisted, with bidirectional triggering in some patients and independent coexistence in others. Sleep health domains (ISI and PSQI subscales) were significantly affected in pCM than in pEM. Excessive sleep-triggered migraine attacks were associated with poorer sleep than inadequate sleep-triggered attacks. On multivariable analysis, a higher MIDAS score, increasing age, and constipation as a prodrome for migraine attacks were each independently associated with poor sleep. In sensitivity analysis, daytime sleepiness (ESS) was significantly associated with migraine disability (MIDAS) (ρ ≈ 0.514, P < 0.001) and poor sleep quality (PSQI) (ρ ≈ 0.682, P < 0.001).</p><p><strong>Conclusions: </strong>Sleep disturbances are common in patients with migraine and are associated with migraine-related disability. Constipation in the prodromal phase of migraine was associated with poor sleep quality, suggesting a potential role of the gut-brain axis in the pathogenesis of sleep disturbances in migraine.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"833-839"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023650","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":"Sensitization and Impaired Habituation of Somatosensory Evoked Potentials in Central Post-stroke Pain.","authors":"Neha Pandey, Jayantee Kalita","doi":"10.4103/aian.aian_84_26","DOIUrl":"10.4103/aian.aian_84_26","url":null,"abstract":"<p><strong>Background and objectives: </strong>Central post-stroke pain (CPSP) is associated with hyperpathia and allodynia, and neurophysiological biomarkers may help to clarify these mechanisms. We report sensitization and impaired habituation of median somatosensory evoked potentials (MSEPs) in CPSP and examine their association with quantitative sensory testing (QST) and clinico-radiological features.</p><p><strong>Methods: </strong>Thirty-four CPSP patients and 18 matched healthy controls were prospectively included. Clinical evaluation, QST, Visual Analog Scale (VAS), Pittsburgh Sleep Quality Index (PSQI), and magnetic resonance imaging (MRI)-based stroke location were recorded. Five consecutive MSEP blocks were obtained bilaterally. N19 latency and amplitude from block 1, as well as habituation across blocks 1 to c5, were analyzed. Impaired habituation was defined as failure of amplitude reduction in blocks 2-5 compared with block 1.</p><p><strong>Results: </strong>CPSP patients showed significantly prolonged N19 latency (21.7 ± 2.25 ms vs 18.8 ± 1.26 ms) and reduced amplitude (3.1 ± 1.57 µV vs 6.2 ± 2.58 µV) compared with controls. N19 amplitude was also reduced on the unaffected side. Tactile threshold correlated with higher pain intensity ( P = 0.04), inversely with allodynia ( P = 0.01), and with extra-thalamic lesions ( P = 0.01). Impaired habituation occurred in 64.7% of CPSP patients and was significantly associated with hyperalgesia ( P = 0.008).</p><p><strong>Conclusions: </strong>CPSP is marked by altered somatosensory processing, reduced cortical excitability, and impaired habituation, reflecting maladaptive thalamocortical plasticity.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"794-802"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178746","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":"Clinical and Metabolic Correlates of Cardiovascular Autonomic Neuropathy in Long-Standing Type 2 Diabetes: A Tertiary-Care Cross-Sectional Study from Eastern India.","authors":"Kaushik Samanta, Dhiman Das, Sudipta Bandyopadhyay, Bidhan C Mandal, Goutam Gangopadhyay","doi":"10.4103/aian.aian_227_26","DOIUrl":"10.4103/aian.aian_227_26","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cardiovascular autonomic neuropathy (CAN) is a serious and underdiagnosed complication of long-standing type 2 diabetes mellitus, associated with increased cardiovascular morbidity and mortality. Data from Indian populations evaluating the relationship between somatic and autonomic neuropathy remain limited.</p><p><strong>Methods: </strong>In this cross-sectional study, 98 patients with long-standing type 2 diabetes were evaluated at a tertiary-care center in Eastern India. Somatic neuropathy was assessed clinically and electrophysiologically, while autonomic function was evaluated using standard cardiovascular autonomic reflex tests and galvanic skin response (GSR). CAN was staged as possible, definite, or advanced. Clinical and metabolic correlates were analyzed, and multivariable logistic regression was used to identify factors independently associated with CAN.</p><p><strong>Results: </strong>Distal symmetric polyneuropathy was present in 44.9% of patients, and any peripheral neuropathy was present in 59.2%. CAN was highly prevalent, with definite and advanced CAN observed in 28.6% and 46.9%, respectively. Abnormal GSR was noted in 42.9%, and overall diabetic autonomic involvement (defined as the presence of CAN and/or isolated sudomotor dysfunction) was present in 92.9%. Increasing CAN severity was associated with higher hemoglobin A1c (HbA1c) ( P = 0.0055), fasting blood glucose ( P = 0.0083), and age ( P = 0.0027), while duration showed a borderline association ( P = 0.0548). HbA1c was the only variable independently associated with CAN after multivariable adjustment (adjusted odds ratio ≈ 2.10 per 1% increase). The sustained handgrip test did not demonstrate a significant association with the presence of CAN (χ 2 , P = 0.712), indicating limited discriminatory ability in this cohort.</p><p><strong>Conclusions: </strong>Autonomic neuropathy, particularly CAN, was highly prevalent in this cohort of patients with long-standing type 2 diabetes. Poorer glycemic control, reflected by higher HbA1c, showed the strongest independent association with CAN. Comprehensive autonomic assessment should be considered even in the absence of overt somatic neuropathy.</p>","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":" ","pages":"772-779"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190845","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}