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Elavarasi A, Goyal V. Botulinum neurotoxin in the treatment of hemifacial spasm associated with myasthenia gravis. Toxicon 2020; 190:1-2. [PMID: 33253699 DOI: 10.1016/j.toxicon.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/29/2020] [Accepted: 11/19/2020] [Indexed: 11/27/2022]
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77
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Garg D, Goyal V. Spinal Tuberculosis Treatment: An Enduring Bone of Contention. Ann Indian Acad Neurol 2020; 23:441-448. [PMID: 33223659 PMCID: PMC7657285 DOI: 10.4103/aian.aian_141_20] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/16/2020] [Accepted: 05/01/2020] [Indexed: 11/04/2022] Open
Abstract
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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Kumar N, Gupta R, Kumar H, Mehta S, Rajan R, Kumar D, Kandadai RM, Desai S, Wadia P, Basu P, Mondal B, Juneja S, Rawat A, Meka SS, Mishal B, Prashanth LK, Srivastava AK, Goyal V. Impact of home confinement during COVID-19 pandemic on sleep parameters in Parkinson's disease. Sleep Med 2020; 77:15-22. [PMID: 33302094 PMCID: PMC7682933 DOI: 10.1016/j.sleep.2020.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 01/23/2023]
Abstract
Background Literature shows that home confinement during coronavirus disease 2019 (COVID-19) pandemic has significantly affected sleep. However, such information regarding subjects having Parkinson's disease (PD) is unavailable. Methods This cross-sectional study was conducted using a questionnaire, developed and validated by experts. PD subjects from nine centers across India were included. Questionnaire assessed presence as well as change in sleep-related parameters and PD symptoms during home confinement. Restless legs syndrome (RLS) and REM sleep behavior disorder (REMBD) was diagnosed using validated questionnaire. Additionally, changes in physical activity, adoption of new hobbies during home confinement and perceived quality of life were assessed. Results Of 832 subjects, 35.4% reported sleep disturbances. New-onset/worsening of sleep disturbances (NOWS) was reported by 23.9% subjects. Among those with sleep disturbances (n = 295), insomnia symptoms worsened in half (51.5%) and nearly one-fourth reported worsening of RLS (24.7%) and REMBD (22.7%) each. NOWS was common in subjects lacking adequate family support during home confinement (P = 0.03); home confinement > 60 days (P = 0.05) and duration of PD > 7 years (P = 0.008). Contrarily, physical activity >1 h/day and engagement in new hobbies during home confinement were associated with better sleep. NOWS was associated with worsening of motor as well as non-motor symptoms of PD (P < 0.001) and poorer life quality (P < 0.001). Conclusion Home confinement during COVID-19 pandemic was significantly associated with NOWS among PD subjects. NOWS was associated with global worsening of PD symptoms and poorer life quality. Physical activity >1 h/day and adoption of new hobbies during home confinement were associated with better sleep.
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Raza MS, Das BK, Goyal V, Lodha R, Chaudhry R, Sood S, Sreenivas V, Nair D, Mohapatra S, Gautam H, Kapil A. IMPACT OF MOLECULAR METHOD FOR THE DIAGNOSIS OF ACUTE BACTERIAL MENINGITIS IN A TERTIARY HEALTH CARE CENTRE IN NORTH INDIA. INTERNATIONAL JOURNAL OF MEDICINE AND MEDICAL RESEARCH 2020. [DOI: 10.11603/ijmmr.2413-6077.2020.1.11103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background. Acute bacterial meningitis is one of the significant infectious diseases that add an immense burden to the health system. Proper management of meningitis is an invincible need to overcome the severe consequences. Objectives. The aim of the study is detection of the etiological agents of acute bacterial meningitis by PCR. Methods. Total 267 CSF samples collected from suspected bacterial meningitis cases were processed for the detection of S. pneumoniae, H. influenzae, N. meningitidis, E. coli and Group B streptococci by conventional and molecular diagnosis method. CSF was inoculated on Blood, chocolate and MacConkey agar plates and incubated at 37 °C for 24-48 hrs. Bacteria grown were identified by Matrix assisted laser desorption/ionization time of flight (MALDI-TOF). Multiplex PCR of the enlisted bacteria was performed using DNA extracted from CSF by DNA extraction kit (Qiagen, USA). Results. 5 (1.87%) out of the total 267 CSF samples were culture positive (3 S. pneumoniae and 2 E. coli) and 28 (10.49%) had detectable DNA by conventional PCR. Out of these 28 samples, 20 (71.43%) were S. pneumoniae and 8 (28.57%) were E. coli. 15 (53.57%) out of total S. pneumoniae were present in children below 5 years of age. Similarly, E. coli was predominant in neonates. Sensitivity and specificity of the PCR was 100% and 95-98% respectively. Conclusions. Streptococcus pneumoniae is the commonest cause of community acquired bacterial meningitis in children below five years of age. Hence, for the promising outcome, PCR should be implemented for the diagnosis of acute bacterial meningitis.
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Parshad R, Verma E, Suhani S, Goyal V, Bhatia R, Sharma R, Datta Gupta S. Surgical and Neurological Outcome of Minimally Invasive Thymectomy in Patients With Myasthenia Gravis: An Experience of 100 Cases Over 6 Years at a Tertiary Care Center in North India. Surg Laparosc Endosc Percutan Tech 2020; 31:227-233. [PMID: 33122592 DOI: 10.1097/sle.0000000000000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Minimally invasive thymectomy (MIT) is emerging as an effective alternative to open thymectomy in the management of patients with myasthenia gravis (MG). The primary objective of our study is to assess the surgical and neurological outcome of MIT in patients with MG. MATERIALS AND METHODS It is a retrospective evaluation of prospectively collected data of 100 patients with MG, who underwent MIT from April 2012 to January 2018 at a tertiary care center in India. Surgical outcome was assessed for success of minimal invasive approach, conversion, perioperative morbidity, and postoperative hospital course. Neurological outcome was assessed, after at least 1 year of follow-up, according to Myasthenia Gravis Foundation of America postintervention status. Factors predicting complete stable remission (CSR) were evaluated. RESULTS MIT was successfully performed in 98% patients with 2% conversion. There was no mortality. Overall, 10% of patients had perioperative morbidity with 5% having exacerbation of neurological symptoms. Two of these needed postoperative ventilation, whereas 3 recovered on conservative treatment. Median operative time and hospital stay were 140 minutes and 3 days, respectively. At a median follow-up of 47 months, CSR was seen in 20% with improvement in 73.3%. Overall, 63% patients were taken off steroids and patients requiring 3 drugs decreased by 70.7%. There was significant reduction in the dosage of pyridostigmine (P<0.001), prednisolone (P<0.001), and azathioprine (P=0.002) after thymectomy. Milder disease (Myasthenia Gravis Foundation of America class 1 and 2) predicted CSR on multivariate analysis. CONCLUSIONS MIT is a safe and effective procedure that leads to improvement in neurological status with significant reduction in number and dosage of medications after thymectomy. Mild disease predicts CSR.
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Pal A, Behari M, Goyal V, Sharma R. Study of EEG microstates in Parkinson's disease: a potential biomarker? Cogn Neurodyn 2020; 15:463-471. [PMID: 34040672 DOI: 10.1007/s11571-020-09643-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/23/2020] [Accepted: 10/06/2020] [Indexed: 11/30/2022] Open
Abstract
The spontaneous activity of the brain is dynamic even at rest and the deviation from this normal pattern of dynamics can lead to different pathological states. EEG microstate analysis of resting-state neuronal activity in Parkinson's disease (PD) could provide insight into altered brain dynamics of patients exhibiting dementia. Resting-state EEG microstate maps were derived from 128 channel EEG data in 20 PD without dementia (PDND), 18 PD with dementia (PDD) and 20 Healthy controls (CON) using Cartool and sLORETA softwares. Microstate map parameters including global explained variance, mean duration, frequency of occurrence (TF) and time coverage were compared statistically among the groups. Eight maps that explained 72% of the topographic variance were identified and only three maps differed significantly across the groups. TF of Map1 was lower in both PDND and PDD (p < 0.001) and that of Map3 (p = 0.02) in PDND compared to control. Cortical sources showed higher activation in precuneus, cuneus and superior parietal lobe (Threshold: Log-F = 1.74, p < 0.05) with maximum activity in the precuneus region (MNI co-ordinates: - 25, - 75, - 40; Log-F = 1.9) in PDND compared to control only for Map1. Lower TF of Map1 (prototypical microstate D) may potentially serve as a biomarker for PD with or without dementia whereas higher activation of precuneus, cuneus and superior parietal lobe at resting-state could favour signal processing, lack of which could be associated with dementia in Parkinson's disorder.
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Kumar N, Gupta R, Kumar H, Mehta S, Rajan R, Kumar D, Kandadai RM, Desai S, Wadia P, Basu P, Mondal B, Sanchita, Rawat A, Meka SS, Mishal B, Prashanth LK, Srivastava AK, Goyal V. Impact of home confinement during COVID-19 pandemic on Parkinson's disease. Parkinsonism Relat Disord 2020; 80:32-34. [PMID: 32937224 PMCID: PMC7474806 DOI: 10.1016/j.parkreldis.2020.09.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/21/2020] [Accepted: 09/03/2020] [Indexed: 01/28/2023]
Abstract
Parkinson's disease symptoms worsened during home confinement. Difficulty in availing formal neurology consultations and/or medicines. Quality of life in Parkinson's disease patients declined during home confinement. Use of telemedicine may benefit patients.
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Peterson JD, Goyal V, Puricelli MD, Thatcher A, Smith RJ. Neonatal Lateral Epiglottic Defects. Ann Otol Rhinol Laryngol 2020; 130:311-313. [PMID: 32772542 DOI: 10.1177/0003489420948546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Multiple congenital abnormalities of the epiglottis have been reported and iatrogenic injuries to the larynx and subglottis are well known. We present a new pattern of defect not previously reported in the literature. METHODS Epiglottic abnormalities at two institutions are reviewed. Cases of defects involving the lateral aspect of the epiglottis and aryepiglottic fold are identified. A literature review of known epiglottic defects is performed. RESULTS Two children possessing lateral notch injuries at the aryepiglottic attachment to the epiglottis are described. Both children have a history of multiple laryngeal instrumentation attempts and prolonged intubation. Both have swallowing difficulties and are gastrostomy dependent. Congenital epiglottic defects include aplasia and midline bifidity, however, no lateral congenital epiglottic defects have been reported. CONCLUSION Epiglottic defects, while rare, should be part of the differential for children with aspiration and feeding difficulties. A new pattern of defect is described and iatrogenic etiology proposed.
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Kumari S, Kumaran SS, Goyal V, Sharma RK, Sinha N, Dwivedi SN, Srivastava AK, Jagannathan NR. Identification of potential urine biomarkers in idiopathic parkinson's disease using NMR. Clin Chim Acta 2020; 510:442-449. [PMID: 32791135 DOI: 10.1016/j.cca.2020.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is the most common neurodegenerative disease caused by the loss of dopamine chemicals resulting in urinary incontinence, gastrointestinal dysfunction, gait impairment and mitochondrial dysfunction. Study investigated urinary metabolic profiles of patients with idiopathic PD as compared to healthy controls (HC) to identify the potential biomarkers. METHODS Urine samples were collected from 100 PD subjects and 50 HC using standard protocol. Metabolomic analyses were performed using high resolution nuclear magnetic resonance (NMR) spectroscopy. The integral values of 17 significant metabolites were estimated and concentration values were calculated, which were subjected to univariate and multivariate statistical analysis. RESULTS We found significantly increased levels of ornithine, phenylalanine, isoleucine, β-hydroxybutyrate, tyrosine and succinate in the urine of patients with PD in comparison with HC. These metabolites exhibited area under the curve greater than 0.60 on ROC curve analysis. We also observed a significant association between succinate concentration and UPDRS motor scores of PD. DISCUSSION Metabolic pathway alterations were observed in aromatic amino acid metabolism, ketone bodies synthesis, branched chain amino acid metabolism and ornithine metabolism. Comprehensive metabolomic profiling revealed variations in urinary signatures associated with severity of idiopathic PD. This profiling relies on non-invasive sampling and is complementary to existing clinical modalities.
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Sawal N, Kanga U, Shukla G, Goyal V, Srivastava AK. Stevens-Johnson syndrome triggered by Levetiracetam—Caution for use with Carbamazepine. Seizure 2020; 80:63-64. [DOI: 10.1016/j.seizure.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022] Open
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86
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Radhakrishnan DM, Goyal V. Levosulpiride-induced Movement Disorders: A Compelling Case for Prudent Use! Ann Indian Acad Neurol 2020; 24:300-301. [PMID: 34220099 PMCID: PMC8232509 DOI: 10.4103/aian.aian_269_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 11/09/2022] Open
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87
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Elavarasi A, Goyal V. Brainstem tuberculoma: A delayed IRIS. Indian J Tuberc 2020; 67:343-345. [PMID: 32825863 DOI: 10.1016/j.ijtb.2018.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 11/16/2018] [Indexed: 06/11/2023]
Abstract
We describe a twenty six years old lady with tuberculous meningitis who developed new onset left ptosis and binocular diplopia with features of left fascicular 3rd nerve palsy after 9 months of anti tubercular therapy (ATT) and imaging revealed new onset tuberculoma in the mid-brain. Tuberculoma responded to steroids while continuing ATT. Formation of new tuberculoma as a part of immune reconstitution inflammatory syndrome (IRIS) is possible even after prolonged therapy of 9 months, which responded well to only steroids without altering ATT.
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Rajan R, Divya KP, Kandadai RM, Yadav R, Satagopam VP, Madhusoodanan UK, Agarwal P, Kumar N, Ferreira T, Kumar H, Sreeram Prasad AV, Shetty K, Mehta S, Desai S, Kumar S, Prashanth LK, Bhatt M, Wadia P, Ramalingam S, Wali GM, Pandey S, Bartusch F, Hannussek M, Krüger J, Kumar-Sreelatha A, Grover S, Lichtner P, Sturm M, Roeper J, Busskamp V, Chandak GR, Schwamborn J, Seth P, Gasser T, Riess O, Goyal V, Pal PK, Borgohain R, Krüger R, Kishore A, Sharma M. Genetic Architecture of Parkinson's Disease in the Indian Population: Harnessing Genetic Diversity to Address Critical Gaps in Parkinson's Disease Research. Front Neurol 2020; 11:524. [PMID: 32655481 PMCID: PMC7323575 DOI: 10.3389/fneur.2020.00524] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/13/2020] [Indexed: 12/21/2022] Open
Abstract
Over the past two decades, our understanding of Parkinson's disease (PD) has been gleaned from the discoveries made in familial and/or sporadic forms of PD in the Caucasian population. The transferability and the clinical utility of genetic discoveries to other ethnically diverse populations are unknown. The Indian population has been under-represented in PD research. The Genetic Architecture of PD in India (GAP-India) project aims to develop one of the largest clinical/genomic bio-bank for PD in India. Specifically, GAP-India project aims to: (1) develop a pan-Indian deeply phenotyped clinical repository of Indian PD patients; (2) perform whole-genome sequencing in 500 PD samples to catalog Indian genetic variability and to develop an Indian PD map for the scientific community; (3) perform a genome-wide association study to identify novel loci for PD and (4) develop a user-friendly web-portal to disseminate results for the scientific community. Our "hub-spoke" model follows an integrative approach to develop a pan-Indian outreach to develop a comprehensive cohort for PD research in India. The alignment of standard operating procedures for recruiting patients and collecting biospecimens with international standards ensures harmonization of data/bio-specimen collection at the beginning and also ensures stringent quality control parameters for sample processing. Data sharing and protection policies follow the guidelines established by local and national authorities.We are currently in the recruitment phase targeting recruitment of 10,200 PD patients and 10,200 healthy volunteers by the end of 2020. GAP-India project after its completion will fill a critical gap that exists in PD research and will contribute a comprehensive genetic catalog of the Indian PD population to identify novel targets for PD.
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Elavarasi A, Goyal V. Hydroxychloroquine and Myasthenia Gravis-Can One Take This Risk? Ann Indian Acad Neurol 2020; 23:360-361. [PMID: 32606531 PMCID: PMC7313600 DOI: 10.4103/aian.aian_363_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 12/05/2022] Open
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Bhyrapuneni G, Goyal V, Pandey S, Muddana N, Palacharla R, Ajjala D, Ravula J, Jetta S, Badange R, Benade V, Nirogi R. 0760 SUVN-G3031, A Potent And Selective Histamine H3 Receptor Inverse Agonist: Safety, Tolerability And Pharmacokinetics Following Single And Multiple Ascending Doses In Healthy Adult Subjects. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
SUVN-G3031 is a potent and selective histamine H3 receptor inverse agonist currently being developed for the treatment of narcolepsy. SUVN-G3031 produced robust wake promoting and anticataplectic effects in animal model relevant to the disease. This supports its therapeutic utility in the treatment of sleep related disorders like narcolepsy with and without cataplexy.
Methods
Two Phase 1 studies were conducted to assess safety, tolerability and pharmacokinetics (PK) of SUVN-G3031. In the first study, single ascending doses of 0.1 mg to 20 mg SUVN-G3031 were administered to healthy subjects. For multiple ascending dose cohorts, doses of 1 mg to 6 mg were administered for 14 days. In the second Phase 1 study, effects of food, gender and age on the PK of SUVN-G3031 were assessed.
Results
SUVN-G3031 absorbed rapidly following single oral administration and the exposures (Cmax and AUC) were dose proportional at the tested doses between 0.1 mg to 20 mg. SUVN-G3031 attained steady state on day six and achieved projected efficacy concentrations following repeated administrations. Food, gender and age had no effect on pharmacokinetics of SUVN-G3031. SUVN-G3031 was well tolerated up to 20 mg/ day single dose and 6 mg repeated dose in healthy adult subjects. There were no serious adverse events reported by any subject during Phase 1 studies.
Conclusion
SUVN-G3031 was well tolerated in humans with adequate plasma exposures for efficacy and has favorable pharmacokinetics suitable for once a day oral administration. SUVN-G3031 is currently being evaluated in a Phase 2 study as monotherapy for the treatment of narcolepsy with and without cataplexy (ClinicalTrials.gov Identifier: NCT04072380).
Support
None
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Nirogi R, Goyal V, Jayarajan P, Bhyrapuneni G, Ravula J, Jetta S, Shinde A. 0759 Phase 2 Proof Of Concept Study Of SUVN-G3031, A Histamine H3 Receptor Inverse Agonist For The Potential Treatment Of Narcolepsy. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
SUVN-G3031 is a potent inverse agonist at histamine H3 receptor (H3R) with selectivity over 70 other targets. SUVN-G3031 has excellent pharmacokinetics in rats and dogs. SUVN-G3031 demonstrated dose dependent receptor occupancy in rats with marked wake-promoting and anticataplectic effects in orexin knockout mice supporting its potential therapeutic utility in the treatment of narcolepsy. Long-term safety studies in animals and Phase 1 evaluation for safety, tolerability and pharmacokinetics demonstrated no concern for further development of SUVN-G3031.
Methods
SUVN-G3031 is currently being evaluated in a Phase 2 proof of concept study in USA for the treatment of narcolepsy with and without cataplexy (ClinicalTrials.gov Identifier: NCT04072380). This is a double-blind, placebo-controlled, parallel-group, multicenter study to evaluate the safety, tolerability, pharmacokinetics and efficacy of SUVN-G3031 in comparison to placebo in patients with narcolepsy with and without cataplexy. Participants with an ESS score of ≥ 12; and mean MWT time of < 12 min are being randomized at a ratio of 1:1:1 to 2 mg SUVN-G3031, 4 mg SUVN-G3031 or placebo. Patients are to be stratified based on the type of narcolepsy. Each patient will receive study drug once daily for 14 days. The primary objective of the study is to evaluate the effectiveness of SUVN-G3031 compared to placebo as measured by an improvement in the maintenance of wakefulness test (MWT) score. Various secondary, exploratory, safety endpoints and steady state plasma concentrations will be evaluated.
Results
This study has been initiated in Q3 2019 and subject recruitment is expected to be completed by Q2 2020.
Conclusion
This study is a phase 2 clinical trial evaluating the efficacy and safety of SUVN-G3031 as a monotherapy in patients with narcolepsy with and without cataplexy. Safety and efficacy results from the study are expected in Q3 2020.
Support
None
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Chaudhary S, Kumaran SS, Goyal V, Kaloiya GS, Kalaivani M, Jagannathan NR, Sagar R, Mehta N, Srivastava AK. Cortical thickness and gyrification index measuring cognition in Parkinson's disease. Int J Neurosci 2020; 131:984-993. [PMID: 32423354 DOI: 10.1080/00207454.2020.1766459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Cortical dynamics is driven by cortico-cortical connectivity and it characterizes cortical morphological features. These brain surface features complement volumetric changes and may offer improved understanding of disease pathophysiology. Hence, present study aims to investigate surface features; cortical thickness (CT) and gyrification index (GI) in Parkinson's disease (PD) patients of normal cognition (PD-CN), cognitively impaired patients with PD (PD-CI) in comparison with cognitively normal healthy controls (HC) to better elucidate cognition linked features in PD. METHOD Anatomical MRI (3DT1) was carried out in 30 HC (56.53 ± 8.42 years), 30 PD-CN (58.8 ± 6.07 years), and 30 PD-CI (60.3 ± 6.43 years) subjects. Whole brain ROI based parcellation using Desikan-Killiany (DK-40) atlas followed by regional CT and GI differentiation [with 'age' and 'total intracranial volume' (TIV) correction], multiple linear regression (with 'age', 'TIV', and 'education' correction) with clinical variables, ROC analysis, and CT-GI correlation across the groups was used for data analysis. RESULTS Widespread cortical thinning with regional GI reduction was evident in PD-CI with respect to other two groups (HC and PD-CN), and with absence of such alterations in PD-CN compared to HC. Frontal, parietal, and temporal CT/GI significantly correlated with cognition and presented classification abilities for cognitive state in PD. Mean regional CT and GI were found negatively correlated across groups with heterogeneous regions. CONCLUSION Fronto-parietal and temporal regions suffer cognition associated cortical thinning and GI reduction. CT may serve better discriminator properties and may be more consistent than GI in studying cognition in PD. Heterogeneous surface dynamics across the groups may signify neuro-developmental alterations in PD.
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Agarwal A, Garg D, Goyal V, VY V, Singh MB, Srivastava MVP. Acute encephalopathy followed by delayed myelopathy: A rare presentation of organophosphate poisoning. Trop Doct 2020; 50:162-164. [DOI: 10.1177/0049475519899580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Organophosphorus compounds (OPC) are commonly used pesticides and suicidal ingestion is a common mode of poisoning. The manifestation of OPC poisoning and its severity depend upon the type, dose and potency of the OPC consumed. Neurological presentations are well defined clinical syndromes consisting of early, intermediate and delayed manifestations (rare), categorised on the basis of time elapsed since OPC exposure. We report a rare delayed manifestation of organophosphorus poisoning in the form of pure motor spastic paraparesis due to dorsal myelopathy. A possibility of delayed manifestations of toxicity should be considered in individuals presenting with features suggestive of myelopathy and a previous history of organophosphate exposure.
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Gupta P, Goyal V, Srivastava AK, Pandit AK, Prasad K. Uveitis, optic neuritis and MOG. Mult Scler J Exp Transl Clin 2020; 6:2055217320925107. [PMID: 32489673 PMCID: PMC7238848 DOI: 10.1177/2055217320925107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Srivastava A, Sharma R, Goyal V, Chaudhary S, Sood SK, Kumaran SS. Saccadic Eye Movements in Young-Onset Parkinson's Disease - A BOLD fMRI Study. Neuroophthalmology 2020; 44:89-99. [PMID: 32395155 DOI: 10.1080/01658107.2019.1652656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/19/2019] [Accepted: 08/02/2019] [Indexed: 10/25/2022] Open
Abstract
The objective of the present study was to understand control of saccadic eye movements in patients with young onset Parkinson's disease (YOPD) where onset of disease symptoms appears early in life (<40 years of age). Functional magnetic resonance imaging (fMRI) was performed in patients with YOPD and control subjects while they performed saccadic tasks, which consisted of a reflexive task and another task that required inhibitory control of eye movements (Go-NoGo task). Functional imaging related to saccadic eye movements in this group of patients has not been widely reported. A 1.5T MR scanner was used for structural and functional imaging. Analysis of blood-oxygen-level-dependent (BOLD) fMRI was performed using Statistical Parametric Mapping (SPM) software and compared in patients and controls. In patients with YOPD greater activation was seen significantly in the middle frontal gyrus, medial frontal gyrus, angular gyrus, cingulate gyrus, precuneus and cerebellum, when compared with the control group, during the saccadic tasks. Gap and overlap protocols revealed differential activation patterns. The abnormal activation during reflexive saccades was observed in the overlap condition, while during Go-NoGo saccades in the gap condition. The results suggest that impaired circuitry in patients with YOPD results in recruitment of more cortical areas. This increased frontal and parietal cortical activity possibly reflects compensatory mechanisms for impaired cognitive and saccadic circuitry.
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Singh N, Goyal V. Thymectomy in Non-Thymomatous Myasthenia Gravis: Does An RCT Solve The 75-Year-Old Controversy? Ann Indian Acad Neurol 2020; 23:10-12. [PMID: 32055115 PMCID: PMC7001447 DOI: 10.4103/aian.aian_162_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 03/25/2019] [Accepted: 05/05/2019] [Indexed: 11/11/2022] Open
Abstract
The role of thymectomy in thymomatous myasthenia gravis (MG) is unambiguous. However, its role in non-thymomatous MG (NTMG) remains debatable. The evidence till date is not robust. In this short review, we try to see the pros and cons of thymectomy in NTMG and critically appraise the evidence available till date.
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Reddy SPK, Vishnu VY, Goyal V, Singh MB, Arora S, Garg A, Srivastava MVP. CADASIL syndrome and stroke in young people. QJM 2020; 113:118-119. [PMID: 31584664 DOI: 10.1093/qjmed/hcz243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/14/2019] [Indexed: 11/14/2022] Open
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98
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Kumari S, Kumaran SS, Goyal V, Bose S, Jain S, Dwivedi SN, Srivastava AK, Jagannathan NR. Metabolomic analysis of serum using proton NMR in 6-OHDA experimental PD model and patients with PD. Neurochem Int 2020; 134:104670. [PMID: 31917997 DOI: 10.1016/j.neuint.2020.104670] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/30/2019] [Accepted: 01/04/2020] [Indexed: 12/12/2022]
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Singh N, Bhatia R, Bali P, Sreenivas V, Padma MV, Goyal V, Saxena R, Dash D, Garg A, Joseph SL. Clinical Features, Gender Differences, Disease Course, and Outcome in Neuromyelitis Optica Spectrum Disorder. Ann Indian Acad Neurol 2020; 24:186-191. [PMID: 34220061 PMCID: PMC8232474 DOI: 10.4103/aian.aian_334_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/03/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is an astrocytopathy with a predilection for the optic nerve, spinal cord, and brainstem. In this ambispective study, we evaluate clinical characteristics, responses to therapy, and disability outcomes in patients with NMOSD. Methods: Patients diagnosed as NMOSD and following up for at least 1 year at a tertiary care center in India were recruited. Patient data were collected ambispectively from January 2012 until December 2018. Results: A total of 106 patients (29M/77F) with NMOSD were evaluated. The mean age of onset was 29 (±11.6) years. About 77 patients (72.64%) were positive for the AQP4 antibody. Age of onset was higher for those presenting with an opticospinal syndrome (34.2 years) as compared to either isolated longitudinally extensive transverse myelitis (LETM) (30 years) or optic neuritis (ON) (25.3 years). The most common syndrome at onset was LETM in 57 patients (53.77%) followed by ON in 31 patients (29.24%). Azathioprine was the most common immunotherapy (83.96%) prescribed followed by rituximab (7.54%) and mycophenolate mofetil (1.88%). There was a significant decrease in the number of relapses post-azathioprine (P < 0.001). Out of 67 patients with ON, 21 (31.34%) had complete recovery while 17 (25.37%) patients had a severe deficit at a 3-month follow-up. Out of 92 patients with a motor deficit, 49 (53.26%) patients had a partial motor deficit at a 6-month follow-up. The severe visual deficit at baseline and female gender predicted poor visual and motor recovery, respectively. Conclusion: This is the largest descriptive study on patients with NMOSD from India. Relapse rates were similar irrespective of the clinical presentation, age, gender, and disease course. Treatment with immunosuppressive treatment significantly affected the disease course.
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Pedapati R, Bhatia R, Singh N, Bali P, Gupta P, Saxena R, Dash D, Singh MB, Goyal V, Srivastava MVP. Anti-myelin oligodendrocyte glycoprotein antibody associated disease spectrum - A north Indian tertiary care centre experience and review of literature. J Neuroimmunol 2020; 340:577143. [PMID: 31931436 DOI: 10.1016/j.jneuroim.2019.577143] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/27/2019] [Accepted: 12/31/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION MOG antibody associated disease is a relatively new disorder for which the full clinical spectrum is being described and the literature is evolving. The current study outlines the observations on a cohort of patients diagnosed with this clinical entity. METHODS This is a retrospective review of prospectively followed up patients with MOG antibody positive neurological illness. Case records of patients following up in neuroimmunology clinic of All India Institute of Medical Sciences(AIIMS), New Delhi from January 2007 to July 2019 were reviewed for MOG antibody positivity and those patients with positive antibody result were included in this study. FINDINGS A total of 20 patients were tested positive for MOG-IgG antibody. 75% were females. Median (Range) age was 30.5 years (8-58). Median disease duration was 22 months (1-139). Most common symptom at presentation was decrease in vision (unilateral or bilateral) (80%). Most common syndrome at onset was unilateral optic neuritis (ON) (40%) followed by bilateral ON (35%), transverse myelitis (TM)(15%), ON plus TM (5%) and cerebral syndrome (5%). Median number of demyelinating episodes per person was 2.5. Out of 29 affected eyes, 26 had good outcome. Out of 7 patients with motor disability, 5 patients had good outcome. CONCLUSION MOG antibody associated disease presents predominantly as recurrent ON, but may also present as an opticospinal, cerebral or brainstem syndrome and recurrent myelitis. Many of the patients had relapses, but had good outcomes with treatment.
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